Association between Meniscal Injuries at the Time of an Anterior Cruciate Ligament Reconstruction and Lower Return-to-Sport Rates: An Analysis at 5 Years of Follow-up of the MERIscience Cohort.

Abstract

Background: While meniscal tears, particularly when treated by meniscectomy concurrent with anterior cruciate ligament reconstruction (ACLR), are known to increase the risk of osteoarthritis and lead to poorer outcomes, their effects on return to sport (RTS) have been little studied so far.

Purpose: To assess the effect of meniscal tears on RTS in the context of ACLR depending on the affected meniscus.

Study design: Cohort study; Level of evidence, 3.

Methods: The authors conducted a retrospective analysis based on data from a prospective cohort single-center study involving 504 patients who received the same postoperative follow-up for a minimum of 3 years between April 2015 and December 2019. The preinjury Tegner Activity Scale score was collected preoperatively, and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) score was collected 6 months after surgery. At the last follow-up, information such as RTS levels, return to the same sport and same athletic level, Self Knee Value, International Knee Documentation Committee score, ACL-RSI score, Tegner score, graft failure, contralateral rupture, and reintervention was collected. Isolated ACLR was compared with ACLR involving medial meniscus (MM), lateral meniscus (LM), and bi-menisci (BM) injuries, and then meniscal repair and meniscectomies were compared for MM and LM injuries.

Results: A total of 504 patients were included with a mean follow-up of 4.9 ± 1.2 years; 6 patients were lost to follow-up. The mean postoperative Tegner score was significatively lower for ACLR with MM injuries than for isolated ACLR (5.4 ± 2.0 vs 6.0 ± 2.0; P = .01). Compared with isolated ACLR (93.9%), the RTS rate was significantly lower for MM injuries (85.1%) and BM injuries (84.1%) (P = .02). Outcomes were similar in ACLR with LM and in isolated ACLR. MM repairs significantly increased the mean Tegner score compared with MM meniscectomies (5.8 ± 1.9 vs 4.7 ± 2.1; P < .001). No other significant differences were found on RTS.

Conclusion: MM tears encountered at the time of ACLR led to a lower Tegner score and a lower RTS rate. Patients undergoing MM repair had higher postoperative activity levels than those undergoing meniscectomy. These findings highlight the importance of repairing MM tears whenever possible at the time of ACLR.