Partial meniscectomy adversely affects return-to-sport outcome after anatomical double-bundle anterior cruciate ligament reconstruction

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 27; no. 3; pp. 912 - 920
• Main Authors: Akada, Takanori, Yamaura, Ichiro, Gupta, Ashish, Sakai, Hiroki, Takahashi, Kenji, Tsuchiya, Akihiro
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-03-2019; Springer Nature B.V
• Subjects: Adolescent; Adult; Anterior cruciate ligament; Anterior Cruciate Ligament Reconstruction - methods; Body mass; Bundling; Failure; Female; Females; Follow-Up Studies; Graft rejection; Grafting; Grafts; Humans; Knee; Ligaments; Male; Males; Medicine; Medicine & Public Health; Meniscectomy - adverse effects; Meniscectomy - methods; Meniscus; Orthopedics; Patients; Postoperative infection; Recovery of function; Retrospective Studies; Return to Sport; Risk analysis; Risk factors; Subgroups; Surgery; Tendons - transplantation; Young Adult; Anterior knee stability; Return to sport; Partial meniscectomy; Anterior cruciate ligament; Graft failure
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-018-5213-y

Purpose
The purposes of this study were to determine whether the partial meniscectomy combined with ACL reconstruction affect the postoperative return-to-sport and to identify if partial meniscectomy has an influence on the graft failure following an anatomical double-bundle ACL reconstruction case.
Methods
A retrospective cohort study including 426 primary double bundle ACL reconstruction cases. There were 206 males and 220 females, median age of 28.4 years, median BMI of 23.0, median preinjury Tegner score of 7.0 and median follow-up period after surgery of 24.0 months. Patients with less than 12 months of follow-up, revision surgery, multi-ligaments injury, previous contralateral knee ligaments injury and postoperative infection cases were excluded. Furthermore, patients who had meniscal repair were excluded in order to compare the outcomes between patients who had intact menisci and those who underwent partial meniscectomy. There were 227 patients with intact menisci (group A) and 199 patients with partial meniscectomy (group B). The median age was younger and the preoperative Tegner score was higher in group A. The patients in group B were subcategorized as the site of partial meniscectomy, including medial (group C), lateral (group D) and bicompartmental (group E) meniscectomy. There were 74, 94, and 31 patients in group C, D, and E, respectively. Return-to-sport (running and sport phase) and graft failure were included in our primary outcomes, and functional outcome as Lysholm knee scores was included in secondary outcome.
Results
The rate of return to running phase and sport phase were 91% (387/426) and 76% (303/399), the mean time taken to return to running and sport phase were 5.7 months and 11.1 months, respectively. There was significant difference in the returning to sport phase between group A and B (
p
 = 0.01), and between group A and D/E subgroups (
p
 = 0.007). There were fourteen graft failures (3.5%) in total. In addition, 9 and 5 graft failures in group A and B, respectively. Of the 5 graft failures in group B, 2 and 3 graft failures in group C and D, respectively. There was no significant difference of the graft failure ratio among the groups.
Conclusion
Our study demonstrates that partial meniscectomy has an adverse effect on the return to sport phase following the anatomical double-bundle ACL reconstruction. Therefore, greater postoperative care would be needed to return to sport with partial meniscectomy in ACL reconstruction cases. On the contrary, partial meniscectomy is not considered to be the risk factor for graft failure at short-term follow-up.
Level of evidence
Case–control study, Level III.