Conservative treatment of meniscal tears in anterior cruciate ligament reconstruction

• Published in: The knee 2016-08, Vol.23 (4), p.642-646
• Main Authors: Alessio-Mazzola, Mattia, Formica, Matteo, Coviello, Matteo, Basso, Marco, Felli, Lamberto
• Format: Article
• Language: English
• Subjects: ACL reconstruction; Adult; Anterior Cruciate Ligament Reconstruction - methods; Arthroscopy; Conservative Treatment; Failure; Female; Humans; Joint Instability - surgery; Joint Instability - therapy; Knee; Knee Injuries - surgery; Knee Injuries - therapy; Ligaments; Male; Meniscal tears; Menisci, Tibial - surgery; Orthopedics; Retrospective Studies; Skin & tissue grafts; Sports injuries; Surgery; Tibial Meniscus Injuries - surgery; Tibial Meniscus Injuries - therapy; Young Adult
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2015.08.003

Abstract Background The management of small, stable meniscal tears within the vascular zone, at time of anterior cruciate ligament (ACL) reconstruction is controversial. The purpose of this study is to evaluate the outcome of meniscal tear "left in situ" at time of the ACL reconstruction. Methods We retrospectively analyzed 175 cases of ACL reconstruction with meniscal tears performed from 2006 to 2012 by the IKDC, KT-1000 and the Tegner Activity Score (TAS). Patients with residual laxity on clinical assessment were selected and considered as subgroup. Clinical outcome and failure rate were evaluated. Results In 83 patients (47.4 %), the arthroscopy revealed a meniscal tear left in situ at time of ACL reconstruction, 45 medial menisci and 38 lateral menisci. Patients were clinically reassessed with a minimum follow up of 24 months (mean 46.53 ± 15.72 months (24 - 79 months). The overall failure rate of conservative treatment of the meniscus in patients with objective residual laxity was 87.5% and 6.7 % in patients with stable knee (P < 0.001). Patient with stable knee had higher postoperative IKDC subjective score (P = 0.0022) and TAS (P < 0.0001). The medial meniscus in patients without residual laxity had higher failure rate compared with lateral meniscus 10.5 % v/s 2.7 % (P = 0.36) and the red-red zone had lower revision rate compared with red-white zone (P = 0.0322). Conclusions The conservative treatment of small and stable peripheral tears of medial and lateral meniscus had low failure rate and no described complications with stable knee after ACL reconstruction. Residual laxity significantly increases the failure rate.