Anterior Cruciate Ligament Reconstruction With Concomitant Meniscal Repair: Is Graft Choice Predictive of Meniscal Repair Success?

Hytham S Salem, Laura J Huston, Alexander Zajichek, Eric C McCarty, Armando F Vidal, Jonathan T Bravman, Kurt P Spindler, Rachel M Frank, MOON Knee Group, Annunziato Amendola, Jack T Andrish, Robert H Brophy, Morgan H Jones, Christopher C Kaeding, Robert G Marx, Matthew J Matava, Richard D Parker, Michelle L Wolcott, Brian R Wolf, Rick W Wright, Hytham S Salem, Laura J Huston, Alexander Zajichek, Eric C McCarty, Armando F Vidal, Jonathan T Bravman, Kurt P Spindler, Rachel M Frank, MOON Knee Group, Annunziato Amendola, Jack T Andrish, Robert H Brophy, Morgan H Jones, Christopher C Kaeding, Robert G Marx, Matthew J Matava, Richard D Parker, Michelle L Wolcott, Brian R Wolf, Rick W Wright

Abstract

Background: When meniscal repair is performed during anterior cruciate ligament (ACL) reconstruction (ACLR), the effect of ACL graft type on meniscal repair outcomes is unclear.

Hypothesis: The authors hypothesized that meniscal repairs would fail at the lowest rate when concomitant ACLR was performed with bone--patellar tendon--bone (BTB) autograft.

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

Methods: Patients who underwent meniscal repair at primary ACLR were identified from a longitudinal, prospective cohort. Meniscal repair failures, defined as any subsequent surgical procedure addressing the meniscus, were identified. A logistic regression model was built to assess the association of graft type, patient-specific factors, baseline Marx activity rating score, and meniscal repair location (medial or lateral) with repair failure at 6-year follow-up.

Results: A total of 646 patients were included. Grafts used included BTB autograft (55.7%), soft tissue autograft (33.9%), and various allografts (10.4%). We identified 101 patients (15.6%) with a documented meniscal repair failure. Failure occurred in 74 of 420 (17.6%) isolated medial meniscal repairs, 15 of 187 (8%) isolated lateral meniscal repairs, and 12 of 39 (30.7%) of combined medial and lateral meniscal repairs. Meniscal repair failure occurred in 13.9% of patients with BTB autografts, 17.4% of patients with soft tissue autografts, and 19.4% of patients with allografts. The odds of failure within 6 years of index surgery were increased more than 2-fold with allograft versus BTB autograft (odds ratio = 2.34 [95% confidence interval, 1.12-4.92]; P = .02). There was a trend toward increased meniscal repair failures with soft tissue versus BTB autografts (odds ratio = 1.41 [95% confidence interval, 0.87-2.30]; P = .17). The odds of failure were 68% higher with medial versus lateral repairs (P < .001). There was a significant relationship between baseline Marx activity level and the risk of subsequent meniscal repair failure; patients with either very low (0-1 points) or very high (15-16 points) baseline activity levels were at the highest risk (P = .004).

Conclusion: Meniscal repair location (medial vs lateral) and baseline activity level were the main drivers of meniscal repair outcomes. Graft type was ranked third, demonstrating that meniscal repairs performed with allograft were 2.3 times more likely to fail compared with BTB autograft. There was no significant difference in failure rates between BTB versus soft tissue autografts.

Registration: NCT00463099 (ClinicalTrials.gov identifier).

Keywords: ACL reconstruction; allograft; autograft; meniscal repair.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: Research reported in this publication was partially supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award No. R01AR053684 (to K.P.S.) and under award No. K23AR066133, which supported a portion of M.H.J.’s professional effort. Contents of this article are solely the responsibility of the authors and do not necessarily represent official views of the National Institutes of Health. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2021.

Figures

Figure 1.
Figure 1.
Flowchart of patient enrollment. ACL, anterior cruciate ligament.
Figure 2.
Figure 2.
Profile plot of the relationship between baseline Marx activity rating score (range, 0-16 points) and risk of subsequent meniscal repair.
Figure 3.
Figure 3.
Relative variable importance by the decrease in bootstrap-validated concordance probability (C-index) upon removal from the full model. ACL, anterior cruciate ligament; BMI, body mass index.

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