title: Meniscal repair with concurrent anterior cruciate ligament reconstruction: operative success and patient outcomes at 6-year follow-up.
abstract: BACKGROUND
  Meniscal repair is commonly performed concurrently with anterior cruciate ligament reconstruction (ACLR) in the acutely injured knee. No large-scale, prospective multicenter studies have evaluated the long-term success and patient-oriented outcomes after combined ACLR and meniscal repair.
  
  
  OBJECTIVE
  To define the operative success and patient-oriented outcome scores 6 years after combined meniscal repair and ACLR.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  All ipsilateral primary ACLR and meniscal repair cases from a multicenter study group between 2002 and 2004 were selected. Validated patient-oriented outcome instruments were completed at 3 time points: preoperatively and then 2 and 6 years after the index procedure. Subsequent ipsilateral knee reoperations were confirmed by operative reports to evaluate for the failure of meniscal repairs.
  
  
  RESULTS
  In total, 286 patients with 1440 primary ACLRs underwent concurrent meniscal repairs (298 meniscal repairs). Of these, 235 (82.2%) were available for follow-up at 6 years (154 medial, 72 lateral, and 9 both lateral and medial meniscal repairs). Repaired menisci most commonly involved the peripheral one third of the meniscus (84%); patterns were typically longitudinal (84%) or displaced bucket-handle (10%), with a mean length of 16.5 ± 5.8 mm. Overall, the meniscal repair failure rate was 14% (medial: 21/154; lateral: 10/72; both: 2/9) at 6 years. Medial repairs failed earlier than lateral repairs (2.1 vs 3.7 years, respectively; P = .01). Significant improvements in outcome scores were sustained at 6-year follow-up. No differences in the suture number or type were detected between repair failures and successes. The rate of meniscal reoperations was higher in patients who underwent repair compared with those who did not have an identified meniscal injury at the time of ACLR (P < .01.
  
  
  CONCLUSIONS
  Concurrent meniscal repair with ACLR is associated with failure rates approximating 14% at 6-year follow-up. Improvements in patient-oriented outcome scores were sustained at 6-year follow-up. Surgeons may expect good clinical outcomes 6 years after combined ACLR and meniscal repair.
authors.affiliation: University of Iowa, Iowa City, Iowa, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Westermann
authors.affiliation: Barnes-Jewish Hospital, Washington University in St Louis, St Louis, Missouri, USA.
authors.forename: Rick W
authors.initials: RW
authors.lastname: Wright
authors.affiliation: Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Kurt P
authors.initials: KP
authors.lastname: Spindler
authors.affiliation: Vanderbilt University, Nashville, Tennessee, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Huston
authors.affiliation: University of Iowa, Iowa City, Iowa, USA Brian-wolf@uiowa.edu.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Wolf
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D012086:Reoperation; D011795:Surveys and Questionnaires; D000070600:Tibial Meniscus Injuries; D016896:Treatment Outcome; D014481:United States; D014945:Wound Healing
keywords: anterior cruciate ligament (ACL) reconstruction; clinical medicine; meniscal repair; outcome