An intact meniscus is considered a secondary stabilizer of the knee after anterior cruciate ligament reconstruction (ACLR). While loss of the meniscus can increase forces on the anterior cruciate ligament graft after reconstruction, it is unclear whether this increased loading affects the success of the graft after ACLR.
Purpose:
To identify the risk of subsequent knee surgery when meniscectomy, either partial or total, is performed at the time of index ACLR.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
We conducted a matched cohort study using data from the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry. Patients were identified who had a primary ACLR performed between January 1, 2005 and December 31, 2016, with up to 12 years of follow-up. The study sample comprised patients with ACLR who had a lateral meniscectomy (n = 2581), medial meniscectomy (n = 1802), or lateral and medial meniscectomies (n = 666). For each meniscectomy subgroup, patients with ACLR alone were matched to patients with a meniscectomy on a number of patient and procedure characteristics. After the application of matching, Cox proportional hazards regression was used to evaluate the risk of aseptic revision, while competing risks regression was used to evaluate the risk of cause-specific ipsilateral reoperation between meniscectomy and ACLR alone. Analysis was performed for each meniscectomy subgroup.
Results:
After the application of matching, we failed to observe a difference in aseptic revision risk for patients with ACLR and a meniscectomy—lateral (hazard ratio [HR], 0.80; 95% CI, 0.63-1.02), medial (HR, 0.95; 95% CI, 0.70-1.29), or both (HR, 1.25; 95% CI, 0.77-2.04)—as compared with ACLR alone. When compared with patients who had ACLR alone, patients with a lateral meniscectomy had a higher risk for subsequent lateral meniscectomy (HR, 1.89; 95% CI, 1.18-3.02; P = .008), and those with a medial meniscectomy had a lower risk for manipulation under anesthesia (HR, 0.13; 95% CI, 0.02-0.92; P = .041).
Conclusion:
No difference in aseptic revision risk was observed for patients undergoing primary ACLR between groups with and without meniscectomy at the time of index surgery. Partial lateral meniscectomy at the time of index ACLR did associate with a higher risk of subsequent lateral meniscectomy.
AllenPRDenhamRASwanAV.Late degenerative changes after meniscectomy: factors affecting the knee after operation. J Bone Joint Surg Br. 1984;66(5):666-671.
3.
Andersson-MolinaHKarlssonHRockbornP.Arthroscopic partial and total meniscectomy: a long-term follow-up study with matched controls. Arthroscopy. 2002;18(2):183-189.
4.
ChhadiaAMInacioMCMaletisGBCsintalanRPDavisBRFunahashiTT.Are meniscus and cartilage injuries related to time to anterior cruciate ligament reconstruction?Am J Sports Med. 2011;39(9):1894-1899.
5.
CicuttiniFMForbesAYuanyuanWRushGStuckeySL.Rate of knee cartilage loss after partial meniscectomy. J Rheumatol. 2002;29(9):1954-1956.
6.
ClaesSHermieLVerdonkRBellemansJVerdonkP.Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21(9):1967-1976.
7.
ClarkTGAltmanDGDe StavolaBL.Quantification of the completeness of follow-up. Lancet. 2002;359(9314):1309-1310.
8.
CristianiRRonnbladEEngstromBForssbladMStalmanA.Medial meniscus resection increases and medial meniscus repair preserves anterior knee laxity: a cohort study of 4497 patients with primary anterior cruciate ligament reconstruction. Am J Sports Med. 2018;46(2):357-362.
9.
CsintalanRPInacioMCFunahashiTTMaletisGB.Risk factors of subsequent operations after primary anterior cruciate ligament reconstruction. Am J Sports Med. 2014;42(3):619-625.
10.
DejourDPungitoreMValluyJNoverLSaffariniMDemeyG.Tibial slope and medial meniscectomy significantly influence short-term knee laxity following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2019;27(11):3481-3489.
11.
DesaiNAndernordDSundemoD, et al. Revision surgery in anterior cruciate ligament reconstruction: a cohort study of 17,682 patients from the Swedish National Knee Ligament Register. Knee Surg Sports Traumatol Arthrosc. 2017;25(5):1542-1554.
12.
Di BenedettoPDi BenedettoEFiocchiABeltrameACauseroA. Causes of failure of anterior cruciate ligament reconstruction and revision surgical strategies. Knee Surg Relat Res. 2016;28(4):319-324.
13.
EysturoyNHNissenKANielsenTLindM.The influence of graft fixation methods on revision rates after primary anterior cruciate ligament reconstruction. Am J Sports Med. 2018;46(3):524-530.
14.
FabricantPDLakomkinNCruzAISpitzerEMarxRG.ACL reconstruction in youth athletes results in an improved rate of return to athletic activity when compared with non-operative treatment: a systematic review of the literature. J ISAKOS. 2016;1(2):62-69.
15.
FairbankTJ.Knee joint changes after meniscectomy. J Bone Joint Surg Br. 1948;30(4):664-670.
16.
FithianDCPaxtonEWStoneML, et al. Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament–injured knee. Am J Sports Med. 2005;33(3):335-346.
17.
GarrettWEJrSwiontkowskiMFWeinsteinJN, et al. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. J Bone Joint Surg Am. 2006;88(3):660-667.
18.
GianottiSMMarshallSWHumePABuntL.Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study. J Sci Med Sport. 2009;12(6):622-627.
19.
GornitzkyALLottAYellinJLFabricantPDLawrenceJTGanleyTJ.Sport-specific yearly risk and incidence of anterior cruciate ligament tears in high school athletes: a systematic review and meta-analysis. Am J Sports Med. 2016;44(10):2716-2723.
20.
GrassiADi PaoloSLucidiGAMacchiarolaLRaggiFZaffagniniS.The contribution of partial meniscectomy to preoperative laxity and laxity after anatomic single-bundle anterior cruciate ligament reconstruction: in vivo kinematics with navigation. Am J Sports Med. 2019;47(13):3203-3211.
21.
GwathmeyFWJrGolishSRDiduchDR.Complications in brief: meniscus repair. Clin Orthop Relat Res. 2012;470(7):2059-2066.
22.
HerzogMMMarshallSWLundJLPateVMackCDSpangJT.Trends in incidence of ACL reconstruction and concomitant procedures among commercially insured individuals in the United States, 2002-2014. Sports Health. 2018;10(6):523-531.
23.
KarterAJFerraraALiuJYMoffetHHAckersonLMSelbyJV.Ethnic disparities in diabetic complications in an insured population. JAMA. 2002;287(19):2519-2527.
24.
KilcoyneKGDickensJFHaniukECameronKLOwensBD.Epidemiology of meniscal injury associated with ACL tears in young athletes. Orthopedics. 2012;35(3):208-212.
25.
KoebnickCLanger-GouldAMGouldMK, et al. Sociodemographic characteristics of members of a large, integrated health care system: comparison with US Census Bureau data. Perm J. 2012;16(3):37-41.
26.
LevyIMTorzilliPAWarrenRF.The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am. 1982;64(6):883-888.
27.
LindMLundBFaunoPSaidSMillerLLChristiansenSE.Medium to long-term follow-up after ACL revision. Knee Surg Sports Traumatol Arthrosc. 2012;20(1):166-172.
28.
MaletisGBChenJInacioMCFunahashiTT.Age-related risk factors for revision anterior cruciate ligament reconstruction: a cohort study of 21,304 patients from the Kaiser Permanente Anterior Cruciate Ligament Registry. Am J Sports Med. 2016;44(2):331-336.
29.
MaletisGBInacioMCFunahashiTT.Analysis of 16,192 anterior cruciate ligament reconstructions from a community-based registry. Am J Sports Med. 2013;41(9):2090-2098.
30.
MaletisGBInacioMCFunahashiTT.Risk factors associated with revision and contralateral anterior cruciate ligament reconstructions in the Kaiser Permanente ACLR registry. Am J Sports Med. 2015;43(3):641-647.
31.
MallNAChalmersPNMoricM, et al. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med. 2014;42(10):2363-2370.
32.
McCullochPCShybutTBIsamailySK, et al. The effect of progressive degrees of medial meniscal loss on stability after anterior cruciate ligament reconstruction. J Knee Surg. 2013;26(5):363-369.
MusahlVCitakMO’LoughlinPFChoiDBediAPearleAD.The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament–deficient knee. Am J Sports Med. 2010;38(8):1591-1597.
35.
NelsonIRChenJLoveRDavisBRMaletisGBFunahashiTT.A comparison of revision and rerupture rates of ACL reconstruction between autografts and allografts in the skeletally immature. Knee Surg Sports Traumatol Arthrosc. 2016;24(3):773-779.
36.
OiestadBEEngebretsenLStorheimKRisbergMA.Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. Am J Sports Med. 2009;37(7):1434-1443.
37.
ParkinsonBRobbCThomasMThompsonPSpaldingT.Factors that predict failure in anatomic single-bundle anterior cruciate ligament reconstruction. Am J Sports Med. 2017;45(7):1529-1536.
38.
PaxtonESStockMVBrophyRH.Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes. Arthroscopy. 2011;27(9):1275-1288.
39.
PaxtonEWKileyMLLoveRBarberTCFunahashiTTInacioMC.Kaiser Permanente implant registries benefit patient safety, quality improvement, cost-effectiveness. Jt Comm J Qual Patient Saf. 2013;39(6):246-252.
40.
PerssonAGifstadTLindM, et al. Graft fixation influences revision risk after ACL reconstruction with hamstring tendon autografts. Acta Orthop. 2018;89(2):204-210.
41.
Rahr-WagnerLThillemannTMPedersenABLindMC.Increased risk of revision after anteromedial compared with transtibial drilling of the femoral tunnel during primary anterior cruciate ligament reconstruction: results from the Danish Knee Ligament Reconstruction Register. Arthroscopy. 2013;29(1):98-105.
42.
RobbCKempshallPGetgoodA, et al. Meniscal integrity predicts laxity of anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2015;23(12):3683-3690.
43.
RyuRKDunbarWHT. Arthroscopic meniscal repair with two-year follow-up: a clinical review. Arthroscopy. 1988;4(3):168-173.
44.
SandersTLMaradit KremersHBryanAJ, et al. Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med. 2016;44(6):1502-1507.
45.
SandersTLPareekAHewettTE, et al. Long-term rate of graft failure after ACL reconstruction: a geographic population cohort analysis. Knee Surg Sports Traumatol Arthrosc. 2017;25(1):222-228.
46.
SarrajMCoughlinRPSolowM, et al. Anterior cruciate ligament reconstruction with concomitant meniscal surgery: a systematic review and meta-analysis of outcomes. Knee Surg Sports Traumatol Arthrosc. 2019;27(11):3441-3452.
47.
SchemperMSmithTL.A note on quantifying follow-up in studies of failure time. Control Clin Trials. 1996;17(4):343-346.
48.
ShelbourneKDDersamMD.Comparison of partial meniscectomy versus meniscus repair for bucket-handle lateral meniscus tears in anterior cruciate ligament reconstructed knees. Arthroscopy. 2004;20(6):581-585.
49.
ShoemakerSCMarkolfKL.The role of the meniscus in the anterior-posterior stability of the loaded anterior cruciate-deficient knee: effects of partial versus total excision. J Bone Joint Surg Am. 1986;68(1):71-79.
50.
ShybutTBVegaCEHaddadJ, et al. Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament–deficient knee. Am J Sports Med. 2015;43(4):905-911.
51.
SpraggLMPrenticeHAMorrisAFunahashiTTMaletisGBCsintalanRP.Femoral-tibial fixation affects risk of revision and reoperation after anterior cruciate ligament reconstruction using hamstring autograft. Knee Surg Sports Traumatol Arthrosc. 2019;27(11):3518-3526.
52.
SteadmanJRMathenyLMHurstJMBriggsKK.Patient-centered outcomes and revision rate in patients undergoing ACL reconstruction using bone–patellar tendon–bone autograft compared with bone–patellar tendon–bone allograft: a matched case-control study. Arthroscopy. 2015;31(12):2320-2326.
53.
SyamKChouhanDKDhillonMS.Outcome of ACL reconstruction for chronic ACL injury in knees without the posterior horn of the medial meniscus: comparison with ACL-reconstructed knees with an intact medial meniscus. Knee Surg Relat Res. 2017;29(1):39-44.
54.
TejwaniSGPrenticeHAWyattRWBJrMaletisGB.Femoral tunnel drilling method: risk of reoperation and revision after anterior cruciate ligament reconstruction. Am J Sports Med. 2018;46(14):3378-3384.
55.
WernerBCCancienneJMMillerMDGwathmeyFW.Incidence of manipulation under anesthesia or lysis of adhesions after arthroscopic knee surgery. Am J Sports Med. 2015;43(7):1656-1661.
56.
WrightRWMagnussenRADunnWRSpindlerKP.Ipsilateral graft and contralateral ACL rupture at five years or more following ACL reconstruction: a systematic review. J Bone Joint Surg Am. 2011;93(12):1159-1165.
57.
WuWHHackettTRichmondJC.Effects of meniscal and articular surface status on knee stability, function, and symptoms after anterior cruciate ligament reconstruction: a long-term prospective study. Am J Sports Med. 2002;30(6):845-850.
58.
XueXAgalliuIKimMY, et al. New methods for estimating follow-up rates in cohort studies. BMC Med Res Methodol. 2017;17(1):155.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
