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

• Published in: The American journal of sports medicine Vol. 38; no. 5; p. 976
• Main Authors: Krych, Aaron J, Pitts, Ryan T, Dajani, Khaled A, Stuart, Michael J, Levy, Bruce A, Dahm, Diane L
• Format: Journal Article
• Language: English
• Published: United States 01.05.2010
• Subjects: 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
• ISSN: 1552-3365
• DOI: 10.1177/0363546509354055

There are sparse data available regarding outcome of meniscal repair performed at the time of ACL reconstruction in the pediatric and adolescent population. To review the results of meniscal repair performed at the time of ACL reconstruction in pediatric and adolescent patients. Case series; Level of evidence, 4. 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. 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). 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.