Stable Lateral Meniscal Posterior Root Tears Left In Situ at Time of Anterior Cruciate Ligament Reconstruction Are of Minimal Long-Term Clinical Detriment

Arthroscopy. 2021 Dec;37(12):3500-3506. doi: 10.1016/j.arthro.2021.04.075. Epub 2021 May 13.


Purpose: The purpose of this study was to compare long-term patient-reported outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction with untreated stable lateral meniscal posterior root (LMPR) tears to those with an intact meniscus.

Methods: Four hundred ninety-two subjects were followed for a minimum of 15-years post-ACL reconstruction and evaluated by an International Knee Documentation Committee questionnaire. The integrity of the meniscus was classified at surgery. Patients were grouped as either untreated injury to LMPR "with stable tear" (WST) group (n = 52) or intact lateral meniscus "no tear" (NT) group (n = 440). WST group included tears where those with a root avulsion within 9 mm of insertion and parrot beak tears with the integrity of the root attachment maintained. Outcomes were compared between groups.

Results: ACL graft rupture occurred in 10% in the WST group and in 11% in the NT group (P = .78). For participants with an intact graft (n = 440), the mean International Knee Documentation Committee scores were 82, in the WST group, and 87, in the NT group (P = .03), with a small effect size of .32. The WST group had a worse mean pain severity score (P = .04) and higher frequency of pain (P = .03) than the NT group, but the effect size was small (P < 0.3). There was no difference in the overall knee function (P = .209) or International Knee Documentation Committee activity level (P = .882).

Conclusion: There was no adverse clinical outcome to leaving a stable LMPR tear in situ at the time of ACL reconstruction. LMPR tears left in situ were of minimal clinically significant long-term detriment, with outcomes similar to having an intact meniscus. There is an innate desire to fix the broken, but posterior meniscal root avulsions and stable parrot beak tears within 9 mm of insertion may not require intervention. At 15 years postinjury, most patients with a stable tear left in situ continue to enjoy an active lifestyle with a pain-free knee.

Level of evidence: Level III, retrospective comparative study.

MeSH terms

  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries* / surgery
  • Anterior Cruciate Ligament Reconstruction*
  • Humans
  • Menisci, Tibial / surgery
  • Retrospective Studies
  • Tibial Meniscus Injuries* / surgery