Outcomes of ACL Reconstruction with Concomitant Meniscal Surgery: A Retrospective Cohort Study.

Abstract

Background: Anterior cruciate ligament (ACL) injuries are common in sports. These injuries often present with ≥1 meniscal tears, which may affect pre- and postoperative patient outcomes.

Purpose: To compare patient-reported outcome measures (PROMs) between isolated ACL reconstruction (ACLR) and ACLR with concomitant meniscal surgery, such as meniscal repair or arthroscopic partial meniscectomy, over 2 years to aid in preoperative counselling and rehabilitation.

Study design: Cohort study; Level of evidence 3.

Methods: This retrospective study included 415 consecutive patients who underwent ACLR at a tertiary referral hospital between January 2009 and December 2022. PROMs-including the Knee injury and Osteoarthritis Outcomes Score (KOOS) and the Lysholm score-were assessed preoperatively and at the 2-year follow-up between the isolated ACLR group and the ACLR with meniscal surgery group using the Mann-Whitney U test. A Wilcoxon signed-rank test within groups was used to assess preoperative to the 2-year follow-up improvements. Also, 95% CIs were utilized to provide the likely values of the true population mean. Two-tailed significance tests were used, and the statistical significance level was set at P < .05.

Results: The patients in the 2 groups (isolated ACLR group, n = 205 and ACLR with meniscal surgery group, n = 210) had similar baseline characteristics for age, sex, and body mass index (P > .05). The meniscal surgery group showed significantly worse Lysholm scores (71.1 [95% CI, 68.8-73.5] vs 74.9 [95% CI, 72.6-77.1]; P = .017) and KOOS domain scores preoperatively compared with the isolated ACLR group: KOOS Symptoms, 72.4 (95% CI, 69.9-75) versus 77.3 (95% CI, 75-80) (P = .011); KOOS Activities of Daily Living, 81.4 (95% CI, 79-83.7) versus 85.6 (95% CI, 83.6-87.6) (P = .006); KOOS Pain, 76.3 (95% CI, 73.9-78.8) versus 81(95% CI, 78.7-83.2) (P = .006); and KOOS Quality of Life, 39.4 (95% CI, 36.4-42.5) versus 43.9 (95% CI, 41-46.9) (P = .028). However, the KOOS Sport and Recreation domain had a lower and insignificant mean (35.6 [95% CI, 31.7-39.4] vs 39.9 [95% CI, 36.2-43.6]; P = .061). Both groups significantly improved across all PROMs at the 2-year follow-up (P < .001). When compared with the isolated ACLR group, the meniscal surgery group had lower postoperative scores for Lysholm scores (93.8 [95% CI, 92.6-95] vs 95.3 [95% CI, 94.3-96.4]; P = .017), the KOOS Sport and Recreation Function (87.5 [95% CI, 85.1-90] vs 89.6 [95% CI, 87-92.2]; P = .025), and the KOOS Pain (97 [95% CI, 96-98] vs 96.7 [95% CI, 95.9-97.6]; P = .010), with insignificant differences in other KOOS domains (P > .05).

Conclusion: The study demonstrated that patients undergoing ACLR with concurrent meniscal surgery initially showed slightly poorer functional scores compared with those who underwent isolated ACLR. Both groups showed significant postoperative improvements. However, patients requiring surgical intervention for concurrent meniscal injuries can expect poorer functional outcomes than those requiring isolated ACLR, even after 2 years. These data may be important when counselling patients presenting with ACL tears who need to receive surgical treatment.