Low Failure Rates and Favorable Outcomes of Meniscal Repair With Concomitant Anterior Cruciate Ligament Primary Repair at Minimum 2-Year Follow-up

Background: Arthroscopic anterior cruciate ligament (ACL) primary repair (ACLPR) has reemerged as a treatment option for select proximal ACL tears. However, concerns persist regarding its ability to restore knee stability adequately to support meniscal healing after concurrent meniscal repair. Purpose: To evaluate the clinical outcomes after medial and/or lateral meniscus repair in patients undergoing ACLPR, compared with isolated ACLPR (ACLPR-only) and ACLPR with partial meniscectomy (ACLPR-PME). Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients with complete, proximal modified Sherman type 1 and 2 ACL tears who underwent ACLPR between 2008 and 2021 with a minimum 2-year follow-up were included. Patients were categorized into 3 groups: ACLPR-only, ACLPR with meniscal repair (ACLPR-MR), and ACLPR-PME. The primary outcome was the International Knee Documentation Committee (IKDC) Subjective Knee Form score. Secondary outcomes consisted of meniscal repair and ACLPR failure, overall reoperation rates, anterior tibial translation side-to-side difference (ATT SSD), clinical outcomes (Lachman test and pivot-shift test results), and patient-reported outcome measures (PROMs) including the Lysholm score, Forgotten Joint Score–12, Anterior Cruciate Ligament Return to Sport after Injury score, and Tegner activity scale score. Results: A total of 276 patients (ACLPR-only: n = 131; ACLPR-MR: n = 76; ACLPR-PME: n = 69) with a mean age of 39.7 ± 10.7 years (50.4% female) and mean follow-up of 2.9 ± 1.0 years were included (7.4% lost to follow-up). The mean IKDC scores demonstrated no significant difference between groups (ACLPR-only: 89.4 ± 10.3 [95% CI, 87.2-91.6]; ACLPR-MR: 86.7 ± 12.9 [95% CI, 83.6-89.8]; ACLPR-PME: 89.2 ± 9.9 [95% CI, 86.6-91.9]; P = .27). Eight patients (10.5%) in the ACLPR-MR group experienced recurrent meniscal injury. ACLPR failure occurred in 28 patients (10.1%), with no significant difference between groups ( P = .62). Younger age was a significant predictor of ACLPR failure ( P < .01), but not meniscal repair failure ( P = .77). No group differences were observed in ATT SSD (ACLPR-only: 0.8 ± 1.3 mm; ACLPR-MR: 1.1 ± 1.2 mm; ACLPR-PME: 1.2 ± 1.4 mm; P = .34), overall reoperations, Lachman test results, pivot-shift test results, and PROMs (all P > .05). Conclusion: Meniscal repair with ACLPR is not associated with inferior clinical and patient-reported outcomes at the 2-year follow-up when compared with ACLPR-only and ACLPR-PME, with ACLPR-MR demonstrating a meniscal reinjury rate of 10.5%. These findings suggest that ACLPR provides sufficient knee stability to support clinically successful meniscal healing.