Advertisement

Second-Look Arthroscopic Evaluations of Meniscal Repairs Associated With Anterior Cruciate Ligament Reconstruction

      Purpose

      To examine the healing status of meniscal repair performed concomitantly with anterior cruciate ligament (ACL) reconstruction with our current indication and surgical procedure based on second-look arthroscopic results. Additionally, the significance of the demographic and clinical factors that can potentially influence the healing rate was statistically assessed.

      Methods

      Between January 2009 and January 2015, second-look was performed for patients who opted to have tibial screw removal and agreed to have concomitant arthroscopy. The healing status of the repaired meniscus was classified into 3 conditions: healed, incompletely healed, and not healed. In addition, clinical outcomes were evaluated at a minimal 1-year follow-up. The effects of patient factors on the meniscal healing rate were statistically assessed.

      Results

      A total of 217 knees underwent arthroscopic meniscal repair concomitant with ACL reconstruction, while second-look was performed for 105 knees. The average period from index surgery to second-look was 15.0 months. Clinical evaluation was conducted at a mean of 17 months (12-50 months). Based on the second-look arthroscopic findings, 64 menisci, 22 menisci, and 29 menisci were categorized as healed, incompletely healed, and not healed, respectively. When the not healed condition was defined as failed repair, a Tegner activity score of 8 or more, recurrent instability, tears in the red-white to white-white zones, and time from injury to surgery of 4 months or longer were identified as clinical factors significantly correlated with failure (P < .01).

      Conclusions

      Meniscal repair in ACL reconstructed knees with expanded indications achieved a healing rate (including incomplete healing) of 75%. Clinical factors such as high sports activity level, recurrent ACL instability, poor vascularity of the repaired site, and long duration from injury to surgery were shown to impair the healing status.

      Level of Evidence

      Level Ⅳ, therapeutic study, case series.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Westermann R.W.
        • Duchman K.R.
        • Amendola A.
        • Glass N.
        • Wolf B.R.
        All-inside versus inside-out meniscal repair with concurrent anterior cruciate ligament reconstruction a meta-regression analysis.
        Am J Sports Med. 2017; 45: 719-724
        • Brown G.C.
        • Rosenberg T.D.
        • Deffner K.T.
        Inside-out meniscal repair using zone specific instruments.
        Am J Knee Surg. 1996; 9: 144-150
        • McDermott I.D.
        • Amis A.A.
        The consequences of meniscectomy.
        J Bone Joint Surg Br. 2006; 88: 1549-1556
        • Salata M.J.
        • Gibbs A.E.
        • Sekiya J.K.
        A systematic review of clinical outcomes in patients undergoing meniscectomy.
        Am J Sports Med. 2010; 38: 1907-1916
        • Cohen M.
        • Amaro J.T.
        • Ejnisman B.
        • et al.
        Anterior cruciate ligament reconstruction after 10 to 15 years: Association between meniscectomy and osteoarthrosis.
        Arthroscopy. 2007; 23: 629-634
        • Salmon L.J.
        • Russell V.J.
        • Refshauge K.
        • et al.
        Long-term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: Minimum 13-year review.
        Am J Sports Med. 2006; 34: 721-732
        • Noyes F.R.
        • Barber-Westin S.D.
        Arthroscopic repair of meniscus tears extending into the avascular zone with or without anterior cruciate ligament reconstruction in patients 40 years of age and older.
        Arthroscopy. 2000; 16: 822-829
        • Schmitz M.A.
        • Rouse L.M.
        • DeHaven K.E.
        The management of meniscal tears in the ACL-deficient knee.
        Clin Sports Med. 1996; 15: 573-593
        • Barber-Westin S.D.
        • Noyes F.R.
        Clinical healing rates of meniscus repairs of tears in the central-third (red-white) zone.
        Arthroscopy. 2014; 30: 134-146
        • Schillhammer C.K.
        • Reid 3rd, J.B.
        • Rister J.
        • et al.
        Arthroscopy up to date: Anterior cruciate ligament anatomy.
        Arthroscopy. 2016; 32: 209-212
        • Rubman M.H.
        • Noyes F.R.
        • Barber-Westin S.D.
        Arthroscopic repair of meniscal tears that extend into the avascular zone. A review of 198 single and complex tears.
        Am J Sports Med. 1998; 26: 87-95
        • Shino K.
        • Suzuki T.
        • Iwahashi T.
        • et al.
        The resident’s ridge as an arthroscopic landmark for anatomical femoral tunnel drilling in ACL reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1164-1168
        • Morgan C.D.
        • Wojtys E.M.
        • Casscells C.D.
        • Casscells S.W.
        Arthroscopic meniscal repair evaluated by second-look arthroscopy.
        Am J Sports Med. 1991; 19: 632-638
        • Cooper D.E.
        • Arnoczky S.P.
        • Warren R.F.
        Meniscal repair.
        Clin Sports Med. 1991; 10: 529-548
        • Barrett G.R.
        • Field M.H.
        • Treacy S.H.
        • Ruff C.G.
        Clinical results of meniscus repair in patients 40 years older.
        Arthroscopy. 1998; 8: 824-829
        • Harris J.D.
        • Brand J.C.
        • Cote M.P.
        • et al.
        Research pearls: The significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance.
        Arthroscopy. 2017; 33: 1102-1112
        • Nwachukwu B.U.
        • Chang B.
        • Voleti P.B.
        • et al.
        Preoperative short form health survey score is predictive of return to play and minimal clinically important difference at a minimum 2-year follow-up after anterior cruciate ligament reconstruction.
        Am J Sports Med. 2017; 45: 2784-2790
        • Brophy R.H.
        • Wright R.W.
        • David T.S.
        • et al.
        Association between previous meniscal surgery and the incidence of chondral lesions at revision anterior cruciate ligament reconstruction.
        Am J Sports Med. 2012; 40: 808-814
        • Shelbourne K.D.
        • Gray T.
        Anterior cruciate ligament reconstruction with autogenous patellar tendon graft followed by accelerated rehabilitation. A two- to nine-year follow up.
        Am J Sports Med. 1997; 25: 786-795
        • Noyes F.R.
        • Barber-Westin S.D.
        Treatment of meniscus tears during anterior cruciate ligament reconstruction.
        Arthroscopy. 2012; 28: 123-130
        • Jones M.H.
        • Spindler K.P.
        • Fleming B.C.
        • et al.
        Meniscus treatment and age associated with narrower radiographic joint space width 2-3 years after ACL reconstruction: Data from the MOON onsite cohort.
        Osteoarthritis Cartilage. 2015; 23: 581-588
        • Asahina S.
        • Muneta T.
        • Hoshino A.
        • Niga S.
        • Yamamoto H.
        Intermediate-term results of meniscal repair in anterior cruciate ligament-reconstructed knees.
        Am J Sports Med. 1998; 26: 688-691
        • Pujol N.
        • Tardy N.
        • Boisrenoult P.
        • Beaufils P.
        Magnetic resonance imaging is not suitable for interpretation of meniscal status ten years after arthroscopic repair.
        Int Orthop. 2013; 37: 2371-2376
        • Toms A.P.
        • White L.M.
        • Marshall T.J.
        • Donell S.T.
        Imaging the post-operative meniscus.
        Eur J Radiol. 2005; 54: 189-198
        • Vance K.
        • Meredick R.
        • Schweitzer M.E.
        • Lubowitz J.H.
        Magnetic resonance imaging of the postoperative meniscus.
        Arthroscopy. 2009; 25: 522-530
        • Ahn J.H.
        • Wang J.H.
        • Yoo J.C.
        Arthroscopic all-inside suture repair of medial meniscus lesion in anterior cruciate ligament–deficient knees: Results of second-look arthroscopies in 39 cases.
        Arthroscopy. 2004; 20: 936-945
        • Tachibana Y.
        • Sakaguchi K.
        • Goto T.
        • Oda H.
        • Yamazaki K.
        • Iida S.
        Repair integrity evaluated by second-look arthroscopy after arthroscopic meniscal repair with the FasT-Fix during anterior cruciate ligament reconstruction.
        Am J Sports Med. 2010; 38: 965-971
        • Tenuta J.J.
        • Arciero R.A.
        Arthroscopic evaluation of meniscal repairs: Factors that effect healing.
        Am J Sports Med. 1994; 22: 797-802
        • Bach Jr., B.R.
        • Dennis M.
        • Balin J.
        • Hayden J.
        Arthroscopic meniscal repair: Analysis of treatment failures.
        J Knee Surg. 2005; 18: 278-284
        • Greis P.E.
        • Holmstrom M.C.
        • Baradana D.D.
        • Burks R.T.
        Meniscal injury: II. Management.
        J Am Acad Orthop Surg. 2002; 10: 177-187
        • Kurosaka M.
        • Yoshiya S.
        • Kuroda R.
        • Matsui N.
        • Yamamoto T.
        • Tanaka J.
        Repeat tears of repaired menisci after arthroscopic confirmation of healing.
        J Bone Joint Surg Br. 2002; 84: 34-37