Purpose of the study: The purpose of this retrospective analysis was to study clinical and radiological outcome of 95 stable meniscal tears left in place after arthroscopic reconstruction of the anterior cruciate ligament with a free patellar autograft (with or without a lateral component).
Material and methods: We reviewed 86 patients who had undergone arthroscopic treatment for chronic anterior laxity (56% solely anterior laxity) with at least one meniscal lesion left in place after ligamentoplasty. IKDC criteria and ARPEGE scores were recorded. A total of 95 stable meniscal lesions had been left in place: 35 lateral lesions (80% longitudinal tears and 77% posterior lesions) and 60 medial lesions (55% peripheral disinsertions and 90% posterior lesions). The lesions measured a mean 10 mm (range 5-20 mm) for the lateral and medial menisci. Mean follow-up was 4 years (range 3-9 years). These patients were young (mean age 26 years), and predominantly men (75%). The right knee was involved in 53% of the cases.
Results: At last follow-up, 26% of the patients were grade A, 65% B, 7% C and 2% D according to the IKDC criteria. No revision procedure was required for lateral menisci despite the large size of the lesions left in place in certain cases. Among the 60 medial lesions left in place, 10 (17%) had become symptomatic (8 bucket-handle, 1 longitudinal tear, 1 posterior fragment) and required surgery a mean 3 years (range 1-6 years) after ligamentoplasty. There was no statistical difference between functional score, residual laxity, or type of stabilization in patients who had revision surgery for symptomatic meniscal lesions and the others. Inversely, these lesions were statistically larger (p=0.038) than the others (mean 13 mm versus 9.8 mm).
Conclusion: Outcome of stable meniscal lesions left in place after treatment for anterior laxity depends on the meniscus involved. For the lateral meniscus, irrespective of the size of the lesion, therapeutic abstention has no clinical impact at 4 years. Inversely, for the medial meniscus, 37.5% of the lesions measuring more than 10 mm that were left in place required revision while only 9% of those measuring less than 10 mm necessitated subsequent surgery. Beyond 10 mm, therapeutic abstention led to a revision procedure in 17% of the cases, suggesting the usefulness of a discussion on other indications. Stable lesions of the medial meniscus should not be left in place if they measure more than 10 mm.