Advertisement

Healing results of meniscal tears left in situ during anterior cruciate ligament reconstruction: a review of clinical studies

  • Nicolas Pujol
  • Philippe Beaufils
Knee

Abstract

The presence of peripheral meniscal tears is common at the time of anterior cruciate ligament (ACL) reconstruction. Techniques to preserve the maximum amount of meniscal tissue include “non operative” management (tear left alone, without repair or removal), meniscus repair, partial meniscectomy. There is a lack of consensus guidelines about the management of peripheral stable meniscal tears. When to remove, let alone or repair? We performed an evidence-based review of the outcomes of stable meniscal tears left in situ during ACL surgery, in order to assess the effectiveness of this popular procedure. Clinical and anatomical results (arthrography or second look arthroscopy) were analyzed. Our literature search yielded ten relevant studies (9 level IV, 1 level III). The mean time of follow-up was 16 months. Pain or mechanical symptoms related to the medial tibiofemoral joint were reported in 0–66% of cases. Subsequent medial meniscectomy or repair were performed in 0–33% of cases. Pain or mechanical symptoms related to the lateral tibiofemoral joint were reported in 0–18% cases. Subsequent lateral meniscectomy or repair were performed in 0–22% cases. A complete healing occurred in 50–61% cases for the medial meniscus and in 55–74% cases for the lateral meniscus. No definite conclusion can be made with regard to these results. The conservative approach is more effective for lateral menisci. The rate of bad results for the medial meniscus remains high when a conservative treatment is used. For the medial meniscus, repair of stable peripheral tears may be always indicated to decrease the risk of postoperative pain or subsequent meniscectomy.

Keywords

Anterior cruciate ligament Arthroscopy Meniscus tear Meniscus repair ACL reconstruction 

References

  1. 1.
    Arnoczky SP, Warren RF (1983) The microvasculature of the meniscus and its response to injury. An experimental study in the dog. Am J Sports Med 11:131–141PubMedCrossRefGoogle Scholar
  2. 2.
    Asahina S, Muneta T, Yamamoto H (1996) Arthroscopic meniscal repair in conjunction with anterior cruciate ligament reconstruction: factors affecting the healing rate. Arthroscopy 12:541–545PubMedGoogle Scholar
  3. 3.
    Beaufils P, Bastos R, Wakim E, Cho SH, Petit-Jouvet C (1992) Meniscal injury in the plastic reconstruction of the anterior cruciate ligament. Meniscal suture or abstention. Rev Chir Orthop Reparatrice Appar Mot 78:285–291PubMedGoogle Scholar
  4. 4.
    Beaufils P, Cassard X (2004) [Meniscal repair]. Rev Chir Orthop Reparatrice Appar Mot 90:3S49–3S75PubMedGoogle Scholar
  5. 5.
    Cannon WD Jr, Vittori JM (1992) The incidence of healing in arthroscopic meniscal repairs in anterior cruciate ligament-reconstructed knees versus stable knees. Am J Sports Med 20:176–181PubMedCrossRefGoogle Scholar
  6. 6.
    DeHaven KE (1990) Decision-making factors in the treatment of meniscus lesions. Clin Orthop Relat Res 252:49–54PubMedGoogle Scholar
  7. 7.
    Deutsch A, Wyzykowski RJ, Victoroff BN (1999) Evaluation of the anatomy of the common peroneal nerve. Defining nerve-at-risk in arthroscopically assisted lateral meniscus repair. Am J Sports Med 27:10–15PubMedGoogle Scholar
  8. 8.
    Fairbank T (1948) Knee joint changes after meniscectomy. J Bone Joint Surg Br 30:664–670Google Scholar
  9. 9.
    Fitzgibbons RE, Shelbourne KD (1995) “Aggressive” nontreatment of lateral meniscal tears seen during anterior cruciate ligament reconstruction. Am J Sports Med 23:156–159PubMedCrossRefGoogle Scholar
  10. 10.
    Henning CE, Lynch MA (1985) Current concepts of meniscal function and pathology. Clin Sports Med 4:259–265PubMedGoogle Scholar
  11. 11.
    Henning CE, Lynch MA, Clark JR (1987) Vascularity for healing of meniscus repairs. Arthroscopy 3:13–18PubMedGoogle Scholar
  12. 12.
    Howell JR, Handoll HH (2000) Surgical treatment for meniscal injuries of the knee in adults. Cochrane Database Syst Rev 2:CD001353PubMedGoogle Scholar
  13. 13.
    Ihara H, Miwa M, Takayanagi K, Nakayama A (1994) Acute torn meniscus combined with acute cruciate ligament injury. Second look arthroscopy after 3-month conservative treatment. Clin Orthop Relat Res 307:146–154PubMedGoogle Scholar
  14. 14.
    Kobayashi K, Nakayama Y, Shirai Y, Narita T, Mori A (2001) Meniscal tears after anterior cruciate ligament reconstruction. J Nippon Med Sch 68:24–28PubMedCrossRefGoogle Scholar
  15. 15.
    Lerat JL, Chotel F, Besse JL, Moyen B, Binet G, Craviari T, Brunet-Guedj E, Adeleine P, Nemoz JC (1998) The results after 10–16 years of the treatment of chronic anterior laxity of the knee using reconstruction of the anterior cruciate ligament with a patellar tendon graft combined with an external extra-articular reconstruction. Rev Chir Orthop Reparatrice Appar Mot 84:712–727PubMedGoogle Scholar
  16. 16.
    Lynch M (1983) Knee joint surface changes. Long-term follow-up meniscus tear treatment in stable anterior cruciate ligament reconstructions. Clin Orthop Relat Res 172:148–153PubMedGoogle Scholar
  17. 17.
    Pierre A, Hulet C, Locker B, Schiltz D, Delbarre JC, Vielpeau C (2001) Outcome of 95 stable meniscal tears left in place after reconstruction of the anterior cruciate ligament. Rev Chir Orthop Reparatrice Appar Mot 87:661–668PubMedGoogle Scholar
  18. 18.
    Roeddecker K, Muennich U, Nagelschmidt M (1994) Meniscal healing: a biomechanical study. J Surg Res 56:20–27PubMedCrossRefGoogle Scholar
  19. 19.
    Scott GA, Jolly BL, Henning CE (1986) Combined posterior incision and arthroscopic intra-articular repair of the meniscus. An examination of factors affecting healing. J Bone Joint Surg Am 68:847–861PubMedGoogle Scholar
  20. 20.
    Shelbourne KD, Heinrich J (2004) The long-term evaluation of lateral meniscus tears left in situ at the time of anterior cruciate ligament reconstruction. Arthroscopy 20:346–351PubMedGoogle Scholar
  21. 21.
    Shelbourne KD, Rask BP (2001) The sequelae of salvaged nondegenerative peripheral vertical medial meniscus tears with anterior cruciate ligament reconstruction. Arthroscopy 17:270–274PubMedCrossRefGoogle Scholar
  22. 22.
    Talley MC, Grana WA (2000) Treatment of partial meniscal tears identified during anterior cruciate ligament reconstruction with limited synovial abrasion. Arthroscopy 16:6–10PubMedGoogle Scholar
  23. 23.
    van Trommel MF, Simonian PT, Potter HG, Wickiewicz TL (1998) Different regional healing rates with the outside-in technique for meniscal repair. Am J Sports Med 26:446–452PubMedGoogle Scholar
  24. 24.
    Warren RF (1990) Meniscectomy and repair in the anterior cruciate ligament-deficient patient. Clin Orthop Relat Res 252:55–63PubMedGoogle Scholar
  25. 25.
    Weiss CB, Lundberg M, Hamberg P, DeHaven KE, Gillquist J (1989) Non-operative treatment of meniscal tears. J Bone Joint Surg Am 71:811–822PubMedGoogle Scholar
  26. 26.
    Yagishita K, Muneta T, Ogiuchi T, Sekiya I, Shinomiya K (2004) Healing potential of meniscal tears without repair in knees with anterior cruciate ligament reconstruction. Am J Sports Med 32:1953–1961PubMedCrossRefGoogle Scholar
  27. 27.
    Zemanovic JR, McAllister DR, Hame SL (2004) Nonoperative treatment of partial-thickness meniscal tears identified during anterior cruciate ligament reconstruction. Orthopedics 27:755–758PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Orthopaedic DepartmentHopital Andre MignotLe ChesnayFrance

Personalised recommendations