Hana Marmura1,2,3,4, Andrew Firth1,2,3,4, Lachlan Batty2,5,6, Dianne M Bryant1,2,3,4,7,8, Alan M J Getgood9,10,11,12,13. 1. Faculty of Health Sciences, Western University, London, Canada. 2. Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada. 3. Bone and Joint Institute, Western University, London, Canada. 4. Lawson Research, London Health Sciences Centre, London, Canada. 5. OrthoSport Victoria Research Unit, Richmond, Australia. 6. St. Vincent's Hospital, Melbourne, Australia. 7. Schulich School of Medicine and Dentistry, Western University, London, Canada. 8. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada. 9. Faculty of Health Sciences, Western University, London, Canada. alan.getgood@uwo.ca. 10. Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada. alan.getgood@uwo.ca. 11. Bone and Joint Institute, Western University, London, Canada. alan.getgood@uwo.ca. 12. Lawson Research, London Health Sciences Centre, London, Canada. alan.getgood@uwo.ca. 13. Schulich School of Medicine and Dentistry, Western University, London, Canada. alan.getgood@uwo.ca.
Abstract
PURPOSE: To assess how meniscal repair and excision impact short term patient-reported outcome measures (PROMs), knee stability, and early graft rupture rates following primary hamstring anterior cruciate ligament reconstruction (ACLR) with or without lateral extra-articular tenodesis (LET) in a group of young active patients where meniscal repair is commonly advocated. METHODS: Six hundred and eighteen patients under 25 years of age at high-risk of graft failure following ACLR were recruited to the Stability 1 study. Multivariable regression models were developed to identify statistically and clinically significant surgical and demographic predictors of Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee Subjective Knee Form (IKDC), ACL Quality of Life Questionnaire (ACL-QOL) and Marx Activity Rating Scale (MARS) scores. Chi-Square tests of independence were used to explore the association between meniscal status (torn, not torn), meniscal treatment (excision or repair), graft rupture, and rotatory knee laxity. RESULTS: Medial meniscus repair was associated with worse outcomes on the KOOS (β = -1.32, 95% CI: -1.57 to -1.10, p = 0.003), IKDC (β = -1.66, 95% CI: -1.53 to -1.02, p = 0.031) and ACL-QOL (β = -1.25, 95% CI: -1.61 to 1.02, p = n.s.). However, these associations indicated small, clinically insignificant changes based on reported measures of clinical relevance. Other important predictors of post-operative PROMs included age, sex, and baseline scores. Medial meniscus excision and lateral meniscus treatment (repair or excision) did not have an important influence on PROMs. There was no significant association between meniscal treatment and graft rupture or rotatory knee laxity. CONCLUSION: While repairing the medial meniscus may result in a small reduction in PROM scores at two-year follow-up, these differences are not likely to be important to patients or clinicians. Any surgical morbidity associated with meniscal repair appears negligible in terms of PROMs. Meniscal repair does not affect rotatory laxity or graft failure rates in the short term. Therefore, meniscal repair should likely be maintained as the standard of care for concomitant meniscal tears with ACLR. LEVEL OF EVIDENCE: III.
PURPOSE: To assess how meniscal repair and excision impact short term patient-reported outcome measures (PROMs), knee stability, and early graft rupture rates following primary hamstring anterior cruciate ligament reconstruction (ACLR) with or without lateral extra-articular tenodesis (LET) in a group of young active patients where meniscal repair is commonly advocated. METHODS: Six hundred and eighteen patients under 25 years of age at high-risk of graft failure following ACLR were recruited to the Stability 1 study. Multivariable regression models were developed to identify statistically and clinically significant surgical and demographic predictors of Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee Subjective Knee Form (IKDC), ACL Quality of Life Questionnaire (ACL-QOL) and Marx Activity Rating Scale (MARS) scores. Chi-Square tests of independence were used to explore the association between meniscal status (torn, not torn), meniscal treatment (excision or repair), graft rupture, and rotatory knee laxity. RESULTS: Medial meniscus repair was associated with worse outcomes on the KOOS (β = -1.32, 95% CI: -1.57 to -1.10, p = 0.003), IKDC (β = -1.66, 95% CI: -1.53 to -1.02, p = 0.031) and ACL-QOL (β = -1.25, 95% CI: -1.61 to 1.02, p = n.s.). However, these associations indicated small, clinically insignificant changes based on reported measures of clinical relevance. Other important predictors of post-operative PROMs included age, sex, and baseline scores. Medial meniscus excision and lateral meniscus treatment (repair or excision) did not have an important influence on PROMs. There was no significant association between meniscal treatment and graft rupture or rotatory knee laxity. CONCLUSION: While repairing the medial meniscus may result in a small reduction in PROM scores at two-year follow-up, these differences are not likely to be important to patients or clinicians. Any surgical morbidity associated with meniscal repair appears negligible in terms of PROMs. Meniscal repair does not affect rotatory laxity or graft failure rates in the short term. Therefore, meniscal repair should likely be maintained as the standard of care for concomitant meniscal tears with ACLR. LEVEL OF EVIDENCE: III.
Authors: Charles L Cox; Laura J Huston; Warren R Dunn; Emily K Reinke; Samuel K Nwosu; Richard D Parker; Rick W Wright; Christopher C Kaeding; Robert G Marx; Annunziata Amendola; Eric C McCarty; Kurt P Spindler Journal: Am J Sports Med Date: 2014-03-19 Impact factor: 6.202
Authors: Belle L van Meer; Duncan E Meuffels; Wilbert A van Eijsden; Jan A N Verhaar; Sita M A Bierma-Zeinstra; Max Reijman Journal: Br J Sports Med Date: 2015-03-30 Impact factor: 13.800
Authors: Christopher M LaPrade; Grant J Dornan; Lars-Petter Granan; Robert F LaPrade; Lars Engebretsen Journal: Am J Sports Med Date: 2015-04-13 Impact factor: 6.202