Failure Rate of Meniscal Repair With ACL Reconstruction Among Professional Athletes: A Study of 196 Patients From the SANTI Study Group With a Mean Follow-up of 96 Months.

Background: There is still controversy regarding the ideal management method for meniscal tears combined with anterior cruciate ligament (ACL) injury, especially for professional athletes.

Purposes: To (1) describe the incidence of secondary meniscectomy in professional athletes after undergoing meniscal repair concomitant to primary ACL reconstruction (ACLR) and (2) identify the associated risk factors for repair failure of the medial meniscus (MM) and/or lateral meniscus (LM) in this population at long-term follow-up.

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

Methods: This was a retrospective comparative study. Included were professional athletes who underwent arthroscopic primary ACLR and repair of MM and/or LM tears between January 2013 and December 2022and who had ≥2 years of follow-up. Risk factors associated with secondary meniscectomy were analyzed using a Cox proportional hazards model.

Results: Out of 230 professional athletes (mean ± SD age, 23.3 ± 5.0 years; mean Tegner score, 9.3 ± 1.0) who underwent primary ACLR, 196 patients (85.2%) also had meniscal repair. The most common type of graft used was hamstring tendon (74%), and 74% of patients underwent a concomitant lateral extra-articular procedure. Among the 196 patients with meniscal lesions, 37% had LM lesions, 29% had MM lesions, and 34% had both LM and MM lesions. LM tears were repaired in 92.8% of cases, while 7.2% were left in situ. The most common type of repair for LM tears was the all-inside technique. MM tears were repaired in 97.6% of cases, with 2.4% left alone. The most common type of repair for MM tears was the suture hook technique, and no meniscectomies were performed. At a mean follow-up of 95.8 ± 45.1 months, 26 patients (13.3%) underwent a secondary meniscectomy: 7 (5.0%) for LM and 19 (15.4%) for MM. A Cox model revealed no significant risk factors associated with secondary lateral or medial meniscectomy.

Conclusion: At long-term follow-up, the meniscal repair failure rate in this population of patients who underwent primary ACLR was 13.2% overall, 5% for LM tears and 15.4% for MM tears. No risk factors for secondary meniscectomy were found.