High incidence of subsequent re-operation following treatments for medial meniscus tears combined with anterior cruciate ligament reconstruction: second-look arthroscopic study

Sang-Gyun Kim; Soo-Hyun Kim; Jung-Heum Baek; Jae-Gyoon Kim; Ki-Mo Jang; Hong-Chul Lim; Ji-Hoon Bae

doi:10.1186/s43019-019-0009-z

High incidence of subsequent re-operation following treatments for medial meniscus tears combined with anterior cruciate ligament reconstruction: second-look arthroscopic study

Knee Surg Relat Res. 2019 Nov 1;31(1):11. doi: 10.1186/s43019-019-0009-z.

Authors

Sang-Gyun Kim¹, Soo-Hyun Kim², Jung-Heum Baek¹, Jae-Gyoon Kim¹, Ki-Mo Jang³, Hong-Chul Lim⁴, Ji-Hoon Bae⁵

Affiliations

¹ Department of Orthopaedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan‑si, Gyeongki‑do, 15355, Republic of Korea.
² Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
³ Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 145, Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
⁴ Department of Orthopaedic Surgery, Seoul Barunsesang Hospital, 421, Siheung-daero, Geumcheon-gu, Seoul, 08523, Republic of Korea.
⁵ Department of Orthopaedic Surgery, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea. osman@korea.ac.kr.

Abstract

Background: The Multicenter Orthopaedic Outcomes Network (MOON) group recently reported that medial meniscus (MM) repairs are associated with more frequent re-operations when compared to lateral meniscus (LM) repairs. The purpose of this study was to compare the meniscal healing and the incidence of subsequent re-operation of medial and lateral meniscal tears that occurred concurrently with anterior cruciate ligament (ACL) injuries.

Methods: We retrospectively reviewed patients who underwent second-look arthroscopy after primary ACL reconstruction (ACLR) between June 2005 to December 2016. The healing of meniscal tears following repair or left in situ, and re-tear following partial meniscectomy, were evaluated via second-look arthroscopy and compared between medial and lateral meniscus. Moreover, the incidence of subsequent meniscal re-operation after the index ACLR were investigated and compared between medial and lateral meniscus. Subsequent meniscal re-operation was performed in cases of the following three symptomatic meniscus tears: re-tears at the meniscectomy site; new tears; and failed healing of repaired or left in situ meniscus.

Results: There were 148 meniscal tears in 121 patients at index ACLR. There were 62 MM tears, 38 LM tears, and 24 bilateral meniscus tears. At second-look arthroscopy, the "successful healing" rate for tears following repair was higher in LM tears (91.2%) compared to MM tears (80.0%), although it was not statistically significant (p > 0.05). No significant differences were observed in the healing of left in situ tears or re-tear of meniscectomy site between medial and lateral meniscus. Patients with MM tears combined with ACL injuries had a higher incidence of subsequent meniscal re-operation compared to patients with LM tears (25.6% vs 16.1%, p = 0.025).

Conclusions: There was a trend for the successful healing rate to be higher in LM repairs than MM repairs. Subsequent meniscal re-operations after ACLR were more frequent in patients with medial meniscal tears concurrently with ACL injuries in comparison to patients with lateral meniscal tears.

Level of study: Level IV, retrospective case series.

Keywords: Anterior cruciate ligament; Meniscus; Reconstruction; Repair; Second-look arthroscopy.