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Anterior cruciate ligament reconstruction with concomitant meniscal surgery: a systematic review and meta-analysis of outcomes

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

A Correction to this article was published on 13 March 2019

This article has been updated

Abstract

Purpose

The aim of this review was to compare the clinical outcomes of anterior cruciate ligament reconstruction (ACLR) with either meniscal repair or meniscectomy for concomitant meniscal injury. The primary hypothesis was that short-term clinical outcomes (≤ 2-year follow-up) for ACLR concomitant with either meniscal repair or resection would be similar. The secondary hypothesis was that ACLR with meniscal repair would result in better longer term outcomes compared with meniscal resection.

Methods

The authors searched two online databases (EMBASE and MEDLINE) from inception until March 2018 for the literature on ACLR and concurrent meniscal surgery. Two reviewers systematically screened studies in duplicate, independently, and based on a priori criteria. Quality assessment was also performed in duplicate. The Knee injury and Osteoarthritis Outcome Score (KOOS) sub-scale scores at 2 years post-operatively were combined in a meta-analysis of proportions using a random-effects model.

Results

Of 2566 initial studies, 25 studies satisfied full-text inclusion criteria. Mean follow-up was 2.09 years, with a total sample of 37,087 subjects including controls. The meta-analysis demonstrated equivocal results at 2 years, except for KOOS symptom scores which favoured meniscal resection over repair. Mean KT-1000 side-to-side difference (SSD) scores were 1.51 ± 0.60 mm for meniscal repair, 1.96 ± 0.36 mm for meniscal resection, and 1.58 ± 0.20 for control patients (isolated ACLR). Medial meniscal repair showed decreased anterior knee joint laxity compared to medial meniscal resection (P < 0.001). Patients with meniscal repair had higher rates of re-operation (13.3% vs 0.8% for meniscal resection, P < 0.001).

Conclusion

Patients with ACLR combined with meniscal resection demonstrate better symptoms at 2-year follow-up compared to patients with ACLR combined with meniscal repair. ACLR combined with meniscal repair results in decreased anterior knee joint laxity with evidence of improved patient-reported outcomes in the long term, but also higher re-operation rates.

Level of evidence

III.

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Change history

  • 13 March 2019

    Unfortunately, the middle name of Olufemi R. Ayeni was accidentally omitted in the original publication and the author name is corrected here. The original article has been corrected.

Abbreviations

AAOS:

American Academy of Orthopaedic Surgeons

AAOSM:

American Orthopaedic Society for Sports Medicine

ACL:

Anterior cruciate ligament

ACLR:

ACL reconstruction

CKRS:

Cincinnati knee rating system

ESSKA:

European Society for Sports Traumatology, Knee Surgery and Arthroscopy

EQ-5D:

EuroQol-5D

GRADE:

Grading of Recommendations Assessment, Development, and Evaluation

IKDC:

International Knee Documentation Committee

ISAKOS:

International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine

KOOS:

Knee injury and Osteoarthritis Outcome Score

MOON:

Multicenter Orthopaedic Outcomes Network

MR:

Meniscal repair

MM:

Partial menisectomy

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analyses

R-AMSTAR:

Revised Assessment of Multiple Systematic Reviews

RCT:

Randomized controlled trial

MINORS:

Methodological Index for Non-randomized Studies

SSD:

Side-to-side difference

VAS:

Visual Analog Scale

WOMAC:

Western Ontario and McMaster Universities Osteoarthritis Index

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Funding

No funding was received for the implementation of this study.

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Authors and Affiliations

  1. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    Mohamed Sarraj

  2. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Ryan P. Coughlin, Seper Ekhtiari, Nicole Simunovic & Olufemi R. Ayeni

  3. St. George’s University, University Centre Grenada, West Indies, Grenada

    Max Solow

  4. Department of Orthopedic Surgery and the Sports Medicine Center, Mayo Clinic and Mayo Foundation, Rochester, MN, USA

    Aaron J. Krych

  5. Department of Surgery, University of Manitoba, Winnipeg, MB, Canada

    Peter MacDonald

  6. Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, 1200 Main St W, Room 4E15, Hamilton, ON, L8N 3Z5, Canada

    Olufemi R. Ayeni

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Contributions

All authors contributed substantially to conception and design, or acquisition of data, or analysis and interpretation of data; drafted the article or revised it critically for important intellectual content; provided final approval of the version to be published; and agreed to act as guarantor of the work (ensuring that questions related to any part of the work are appropriately investigated and resolved).

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Correspondence to Olufemi R. Ayeni.

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ORA is a paid consultant for ConMed. PM receives fellowship support from Conmed Ossur and Arthrex. The authors have no other potential conflicts of interests to declare.

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 This review did not involve primary data collection from patients and as such research approval was not obtained.

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The original version of this article was revised: The middle name of Olufemi R. Ayeni was accidentally omitted in the original publication.

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Sarraj, M., Coughlin, R.P., Solow, M. et al. Anterior cruciate ligament reconstruction with concomitant meniscal surgery: a systematic review and meta-analysis of outcomes. Knee Surg Sports Traumatol Arthrosc 27, 3441–3452 (2019). https://doi.org/10.1007/s00167-019-05389-3

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