Description
Clinical Outcome of Single-Stage Surgery for Anterior Cruciate Ligament Rupture with Medial Meniscus Locked Bucket Handle Tear.
A Case Control Study with Anterior Cruciate Ligament Rupture with
Non-locked Medial Meniscus Longitudinal Tear.
Kawai Akira, M.D., Kanto Ryo, M.D., Ph.D., Onishi Shintaro (O.S.), M.D., Ph.D.,
Iseki Tomoya (I.T.), M.D., Ph.D., Nakayama Hiroshi (N.H.), M.D., Ph.D.,
Yoshiya Shinichi (Y.S.), M.D., Ph.D., Tachibana Toshiya (T.T.), M.D., Ph.D.
Department of Orhopaedic Surgery, Hyogo Medical University, Hyogo, Japan
1-1, Mukogawa-cho, Nishinomiya, Hyogo, Japan, 663-8501
Purpose
To compare the postoperative outcomes between cases of ACL rupture with concurrent medial meniscus locking, treated with single-stage meniscus repair and ACL reconstruction, and cases of ACL rupture with concomitant medial meniscus longitudinal tear without locking, also treated with single-stage meniscus repair and ACL reconstruction.
Methods
The study retrospectively included 9 cases (9 knees) of ACL rupture with concurrent medial meniscus locking, who visited our department between 2013 to 2021, underwent single-stage meniscus repair and ACL reconstruction and followed up for more than 1 year. These cases were limited to those with persistent knee joint extension loss until the day of surgery and confirmed meniscal rocking during intraoperative arthroscopic examination. Cases in which locking episodes occurred before surgery but were resolved before the operation, cases that underwent surgery within 3 months of ACL rupture, and cases in which remnants were preserved during surgery were excluded. We define this group as the ML group.
As for the control group, it consisted of 18 cases (18 knees) that underwent single-stage surgery for ACL rupture with concurrent non-locking medial meniscus longitudinal tears within the same period at the same facility. These cases were matched to the ML group based on age and sex and were also followed up for more than 1 year. We define this group as the C group. The presence of knee joint extension loss of 5° or more on the affected side and Lysholm score at the final follow-up were evaluated as assessment parameters, and statistical analysis was conducted using the EZR software following the methods described in Mann-Whitney U test and Fisher’s exact test.
Result
There were no significant differences in age between the two groups. However, the period from ACL injury to surgery was longer in the ML group (median; 30 vs 7months, P<0.05), and the follow-up period tended to be longer in the ML group as well (median; 35.0 vs 22.5 months, p<0.05), and the angle of preoperative knee joint extension loss was greater in the ML group (median; 5.0 vs 0.0°, p<0.05). Cases with knee joint extension loss were observed postoperatively in 3 cases (33.3%) in the ML group and in 1 case (5.6%) in the control group, showing a higher occurrence in the ML group (p=0.093). While all cases were able to return to sports activities, the Lysholm score at the final observation was significantly lower in the ML group (median; 90 vs 100, p<0.01).
Conclusion
In cases of ACL injury with persistent knee joint extension loss until just before surgery, accompanied by medial meniscus locking, single-stage surgery resulted in a higher occurrence of postoperative knee joint extension loss compared to single-stage surgery for ACL injury with concurrent non-locking medial meniscus longitudinal tears. Additionally, the Lysholm score at the final follow-up was significantly lower.
