Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Department of Rehabilitation Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Am J Sports Med. 2020 Dec;48(14):3525-3533. doi: 10.1177/0363546520967670. Epub 2020 Oct 30.
One of the goals of anterior cruciate ligament (ACL) reconstruction is a meniscal protective effect on the knee. Despite the advancement of ACL reconstruction techniques, subsequent meniscal tears after ACL reconstruction remain a problem, and the risk factors for recurring lesions are still unclear.
To investigate the incidence of subsequent meniscal surgery after primary ACL reconstruction without revision ACL surgery and to determine the risk factors associated with this reoperation.
Case series; Level of evidence, 4.
Overall, 518 patients who underwent primary ACL reconstruction between 2004 and 2012 at one instution participated in this study. Data on body mass index, graft type and femoral tunnel-drilling technique of ACL reconstruction, and location and type of meniscal injury and its treatment at ACL reconstruction were collected from medical records. Clinical outcomes were investigated, including side-to-side difference of anterior laxity, pivot-shift grade, and subsequent meniscal surgery without ACL insufficiency (at minimum 2-year follow-up).
The prevalence of tears to the medial meniscus (MM) at the primary ACL reconstruction was 43.6% (226/518), 140 of which were repaired; on the contrary, tears of the lateral meniscus (LM) had a prevalence of 55.8% (289/518), 42 of which were repaired. At a mean 30.3 months (range, 8-124 months) after ACL reconstruction, 20 patients (3.9%; 14 MM tears, 3 LM tears, 3 MM + LM tears) required meniscal surgery without ACL reinjury or recurrence of instability. Of these, 14 MMs and 3 LMs had been repaired at primary ACL reconstruction. The failure rates of repaired MM and LM were 10.0% (14/140) and 7.1% (3/42), respectively. The failure rate of MM repair using the all-inside technique (6/36) was significantly higher compared with no treatment, inside-out repair, or partial resection ( = .045). In multiple regression analysis, the presence of MM injury at the time of ACL reconstruction (odds ratio [OR], 7.81; = .003), the side-to-side difference of postoperative anterior tibial translation (OR, 1.91; = .032), and follow-up period after ACL reconstruction (OR, 1.02; = .003) were risk factors of subsequent meniscal surgery after ACL reconstruction.
Incidence of subsequent meniscal surgery after successful ACL reconstruction was <5%. Presence of MM tear at the time of ACL reconsturuction, small amount of increased anterior laxity, and long-term period after ACL reconstruction were predictive of subsequent meniscal surgery.
前交叉韧带（ACL）重建的目标之一是对膝关节产生半月板保护作用。尽管 ACL 重建技术不断进步，但 ACL 重建后随后发生的半月板撕裂仍然是一个问题，并且复发性损伤的风险因素仍不清楚。
研究初次 ACL 重建后无 ACL 再手术的情况下随后进行半月板手术的发生率，并确定与该再手术相关的危险因素。
病例系列；证据水平，4 级。
总体而言，共有 518 名患者于 2004 年至 2012 年在一家机构接受初次 ACL 重建，参与了这项研究。从病历中收集了 ACL 重建的身体质量指数、移植物类型和股骨隧道钻孔技术以及 ACL 重建时半月板损伤的位置和类型及其治疗的数据。对临床结果进行了调查，包括前向松弛的侧别差异、枢轴移位程度以及无 ACL 不足的后续半月板手术（至少 2 年的随访）。
初次 ACL 重建时内侧半月板（MM）撕裂的发生率为 43.6%（226/518），其中 140 例行修复术；相反，外侧半月板（LM）撕裂的发生率为 55.8%（289/518），其中 42 例行修复术。在 ACL 重建后平均 30.3 个月（8-124 个月）时，20 名患者（3.9%；14 例 MM 撕裂，3 例 LM 撕裂，3 例 MM+LM 撕裂）需要进行无 ACL 再损伤或不稳定复发的半月板手术。其中，14 例 MM 和 3 例 LM 在初次 ACL 重建时已行修复术。初次修复的 MM 和 LM 的失败率分别为 10.0%（14/140）和 7.1%（3/42）。采用全内技术修复的 MM 失败率（6/36）明显高于未治疗、内-外技术修复或部分切除术（ =.045）。多因素回归分析显示，ACL 重建时存在 MM 损伤（比值比[OR]，7.81； =.003）、术后胫骨前向平移的侧别差异（OR，1.91； =.032）和 ACL 重建后的随访时间（OR，1.02； =.003）是 ACL 重建后发生后续半月板手术的危险因素。
初次 ACL 重建成功后，半月板手术的发生率<5%。ACL 重建时存在 MM 撕裂、前向松弛增加和 ACL 重建后长期随访是后续半月板手术的预测因素。
