Document Title: Asahina-AJSM-Sep98

Article Title: Intermediate-term results of meniscal repair in anterior-cruciate-ligament-reconstructed knees

Author: Shintaro Asahina MD, Takeshi Muneta MD, Akiho Hoshino, MD, Sadao Niga MD, and Haruyasu Yamamoto,sec MD

Location: Department of Orthopaedic Surgery and Sports Medicine, Kawaguchi Kohgyo General Hospital, Kawaguchi, and Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan

Publication: American Journal of Sports Medicine, Baltimore, Maryland

Date: Sep/Oct 1998

Volume 26, Number 5, pages 688-691

(Figures included. Reference-denoting numbers appear in the same point size as the document text.)

This article discusses meniscal repair in ACL-reconstructed knees. The authors make it clear that the somewhat different biomechanics/kinematics of an ACL-reconstructed knee (as compared to a knee with a natural, uninjured ACL) can compromise a meniscal repair. (But the biomechanics of an ACL-reconstructed knee are still far superior to the biomechanics of a chronically ACL-deficient knee.) The not-so-subtle difference between a natural and a reconstructed ACL arises from the fact that the former consists of several fibre bundles of varying orientation, whereas the latter is merely a single strand or simple rope-like bundle. The authors astutely write: "Even though an ACL reconstruction may make the Lachmann test or pivot shift test negative, the meniscus may still be exposed to excessive stress, even in those knees that are seemingly satisfactorily stabilized. More sophisticated testing may be needed, for example, loaded functional tests and sport-specific descriptions."

ABSTRACT

We investigated the incidence of and risk factors for recurrent tears of repaired menisci in anterior cruciate ligament-reconstructed knees. We observed 63 patients whose menisci had been evaluated at second-look arthroscopy as healed (N = 50) or incompletely healed (N = 13) for an average of 4 years (range, 2 to 9.5). Of the 13 patients with incompletely healed menisci, 6 (46%) required additional meniscal surgery and 2 (15%) had recurrence of meniscal symptoms such as catching or locking. Among the 50 patients with healed menisci, 5 (10%) required additional meniscal surgery and 9 (18%) had recurrence of meniscal symptoms after second-look arthroscopy. The timing of the recurrence of these symptoms was from 12 to 28 months after surgical repair. Of the 11 patients who had undergone additional surgery, 6 had sustained second injuries during sports activities and the other 5 had no identifiable cause of injury. When comparing age, tear sites, rim width, side-to-side differences with KT-1000 arthrometer testing, and the pivot shift test, there were no differences between the group requiring additional surgery, the symptomatic group, and the asymptomatic group. However, the postoperative Tegner activity score of the group requiring additional surgery was statistically significantly higher than the others.

Although many authors have reported high healing rates in repaired menisci based on second-look arthroscopy, most evaluations were performed within 1 year after the repair.3,4,7,8,10,12,13,16 This suggests most knees were evaluated before the patient participated in heavy labor or strenuous sports activities. Few studies have reported recurrent meniscal tears after second-look arthroscopic examination. It is unclear whether the menisci assessed as healed or incompletely healed by second-look arthroscopy will remain intact over subsequent years. Long-term clinical studies of meniscal repair have included little information about these intact menisci.6 9,14 DeHaven et al.6 reported a retear rate of 11% in a series of 80 open meniscal repairs with a 2- to 9-year follow-up. Sommerlath and Hamberg"4 reported on 28 meniscal repairs with a 6- to 8-year follow-up period that were determined to be healed by second-look arthroscopy (N = 20) and clinical assessment (N = 8). At follow-up, 3 of 28 repairs (11%) had torn in connection with minor trauma during sports or activities of daily living. The purpose of this study was to report the results of meniscal repair at an intermediate follow-up in knees that have undergone ACL reconstruction and second-look arthroscopy.

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