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

  • Mohamed Sarraj
  • Ryan P. Coughlin
  • Max Solow
  • Seper Ekhtiari
  • Nicole Simunovic
  • Aaron J. Krych
  • Peter MacDonald
  • Olufemi AyeniEmail author



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.


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.


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).


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



Anterior cruciate ligament reconstruction Meniscectomy Meniscal repair 



American Academy of Orthopaedic Surgeons


American Orthopaedic Society for Sports Medicine


Anterior cruciate ligament


ACL reconstruction


Cincinnati knee rating system


European Society for Sports Traumatology, Knee Surgery and Arthroscopy




Grading of Recommendations Assessment, Development, and Evaluation


International Knee Documentation Committee


International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine


Knee injury and Osteoarthritis Outcome Score


Multicenter Orthopaedic Outcomes Network


Meniscal repair


Partial menisectomy


Preferred Reporting Items for Systematic Reviews and Meta-analyses


Revised Assessment of Multiple Systematic Reviews


Randomized controlled trial


Methodological Index for Non-randomized Studies


Side-to-side difference


Visual Analog Scale


Western Ontario and McMaster Universities Osteoarthritis Index


Author 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).


No funding was received for the implementation of this study.

Compliance with ethical standards

Conflict of interest

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.

Ethical approval

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

Supplementary material

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.DeGroote School of MedicineMcMaster UniversityHamiltonCanada
  2. 2.Division of Orthopaedic Surgery, Department of SurgeryMcMaster UniversityHamiltonCanada
  3. 3.St. George’s University, University Centre GrenadaWest IndiesGrenada
  4. 4.Department of Orthopedic Surgery and the Sports Medicine CenterMayo Clinic and Mayo FoundationRochesterUSA
  5. 5.Department of SurgeryUniversity of ManitobaWinnipegCanada
  6. 6.Department of Health Research Methods, Evidence, and ImpactMcMaster University Medical CentreHamiltonCanada

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