Surgical repair of meniscal tears with concomitant anterior cruciate ligament reconstruction in patients 18 years and younger

Am J Sports Med. 2010 May;38(5):976-82. doi: 10.1177/0363546509354055. Epub 2010 Mar 18.

Abstract

Background: There are sparse data available regarding outcome of meniscal repair performed at the time of ACL reconstruction in the pediatric and adolescent population.

Purpose: To review the results of meniscal repair performed at the time of ACL reconstruction in pediatric and adolescent patients.

Study design: Case series; Level of evidence, 4.

Methods: The records of all patients age 18 years or younger who underwent meniscal repair at the time of ACL reconstruction between 1990 and 2005 were reviewed. Ninety-nine patients (56 female, 43 male) with an average age of 16 years (range, 13-18) were included. Average injury to surgery interval was 107 days (range, 2-1109). Clinical outcomes were assessed at a mean of 8 years postoperatively (range, 2-19). A multivariate model was used to compare this cohort with a previously published cohort of patients with isolated meniscal tears.

Results: The clinical success rate of meniscal repair was 84% for simple tears, 59% for displaced bucket-handle tears, and 57% for complex tears (74% overall). Twenty-six menisci (26% overall) failed repair and 25 patients underwent repeat arthroscopic surgery (19 partial meniscectomies, 6 re-repairs). The average Tegner and International Knee Documentation Committee scores were 6.2 (range, 2-10) and 90.3 (range, 52-100), respectively. Risk factors for failure included complex and bucket-handle tear (P = .01), medial meniscal tears (P = .03), and skeletal immaturity (P = .01). Compared with isolated meniscal repairs in a similar pediatric and adolescent population, complex tears repaired in combination with ACL reconstruction did significantly better (57% vs 13%; P = .004).

Conclusion: Clinically successful repair of meniscal tears treated at the time of ACL reconstruction in patients 18 years or younger depends on tear type, with complex and bucket-handle tears being negative prognostic factors. Complex tears have a higher rate of clinical success when repaired at the time of ACL reconstruction versus when repaired in isolation.

MeSH terms

  • Adolescent
  • Anterior Cruciate Ligament / surgery*
  • Arthroscopy / methods
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Menisci, Tibial / surgery*
  • Orthopedic Procedures / methods*
  • Range of Motion, Articular
  • Reconstructive Surgical Procedures / methods*
  • Reoperation
  • Retrospective Studies
  • Risk Factors
  • Rupture
  • Tibial Meniscus Injuries
  • Treatment Outcome