Olsson Wållgren Jonas, Oeding Jacob F, Kaarre Janina, Hamrin Senorski Eric, Musahl Volker, Samuelsson Kristian
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.
Orthop J Sports Med. 2025 May 5;13(5):23259671251330655. doi: 10.1177/23259671251330655. eCollection 2025 May.
When injuring the anterior cruciate ligament (ACL), simultaneous meniscal tears often occur. However, little data describe ACL reconstruction (ACLR) and the subsequent risk of revision ACLR, as well as cartilaginous and meniscal damage after primary ACLR with different treatments for injury of the lateral meniscus (LM).
To investigate (1) how different LM treatments during primary ACLR affect the odds of revision ACLR and the cartilaginous and meniscal status at revision in a long-term follow-up and (2) whether the increased risk of subsequent meniscal and cartilaginous injuries seen with meniscal resection in the short term would continue in the long term, and (3) the increased risk with subsequent meniscal injuries with meniscal repair.
Cohort study; Level of evidence, 3.
Data from the Swedish National Knee Ligament Registry were used. The study compared 2 groups: patients with isolated ACLR and patients with ACLR and concomitant LM injury, further subdividing the latter into 4 treatment types: repair, resection, both, and left in situ. Patients with medial meniscal injuries were excluded. The main outcomes studied were the odds for revision ACLR and the cartilaginous and meniscal status at revision 5 and 10 years after primary surgery.
Data for 5 years were available for 22,208 patients and data for 10 years were available for 11,058 patients. Compared with isolated ACLR, patients with concomitant LM injury left in situ had higher odds of revision ACLR at both 5 years (odds ratio [OR], 1.49; 95% CI, 1.14-1.95; = .004) and 10 years (OR, 1.55; 95% CI, 1.09-2.19; = .01), while those with LM repair had higher odds at 5 years (OR, 1.73; 95% CI, 1.23-2.43; = .002). LM repair also increased the odds of subsequent meniscal injuries at 5 years (OR, 3.52; 95% CI, 1.76-7.03; = .0004) and 10 years (OR, 7.26; 95% CI, 1.67-31.52; = .008). Partial meniscectomy did not show an increased risk of cartilage injury, subsequent meniscal injury, or revision ACLR at long-term follow-up compared with the control group.
This demonstrates that over 5 and 10 years, LM repair during primary ACLR is associated with an increased risk of revision ACLR and subsequent meniscal injuries. The higher risk of revision ACLR when the LM is left in situ emphasizes the need for careful consideration of treatment methods. Conversely, partial meniscectomy did not show an associated increased risk of cartilaginous injury in the long term and is associated with a lower risk of subsequent meniscal injury and revision ACLR than other treatment options, raising questions about whether preserving the meniscus at all costs is always the best approach.
前交叉韧带（ACL）损伤时，常同时发生半月板撕裂。然而，关于ACL重建（ACLR）及其后续翻修ACL的风险，以及初次ACLR后采用不同外侧半月板（LM）损伤治疗方法后的软骨和半月板损伤情况的数据较少。
调查（1）初次ACLR期间不同的LM治疗方法如何影响长期随访中翻修ACLR的几率以及翻修时的软骨和半月板状况；（2）短期半月板切除术后观察到的半月板和软骨损伤风险增加在长期是否会持续；（3）半月板修复后后续半月板损伤的风险增加情况。
队列研究；证据等级：3级。
使用瑞典国家膝关节韧带注册中心的数据。该研究比较了两组：单纯ACLR患者和ACLR合并LM损伤患者，后者进一步细分为4种治疗类型：修复、切除、两者皆有以及原位保留。排除内侧半月板损伤患者。研究的主要结局是初次手术后5年和10年翻修ACLR的几率以及翻修时的软骨和半月板状况。
22208例患者有5年的数据，11058例患者有10年的数据。与单纯ACLR相比，原位保留LM损伤的患者在5年（优势比[OR]，1.49；95%可信区间[CI]，1.14 - 1.95；P = 0.004）和10年（OR，1.55；95% CI，1.09 - 2.19；P = 0.01）时翻修ACLR的几率更高，而进行LM修复的患者在5年时几率更高（OR，1.73；95% CI，1.23 - 2.43；P = 0.002）。LM修复在5年（OR，3.52；95% CI，1.76 - 7.03；P = 0.0004）和10年（OR，7.26；95% CI，1.67 - 31.52；P = 0.008）时也增加了后续半月板损伤的几率。与对照组相比，长期随访时部分半月板切除术未显示软骨损伤、后续半月板损伤或翻修ACLR的风险增加。
这表明在5年和10年期间，初次ACLR时进行LM修复与翻修ACLR及后续半月板损伤风险增加相关。LM原位保留时翻修ACLR风险较高，这强调了仔细考虑治疗方法的必要性。相反，部分半月板切除术长期未显示软骨损伤风险增加，且与其他治疗选择相比，后续半月板损伤和翻修ACLR风险较低，这引发了是否不惜一切代价保留半月板总是最佳方法的疑问。
