ACL and Meniscus Surgery: A Comprehensive Guide to Combined Procedures

Introduction

Anterior cruciate ligament (ACL) tears often occur in conjunction with meniscal injuries, presenting a complex challenge for orthopedic surgeons. This comprehensive guide delves into the nuances of combined ACL and meniscus surgery, exploring the latest techniques, outcomes, and the critical importance of meniscus preservation for long-term knee health.

The Importance of Meniscus Preservation

The menisci play a crucial role in knee biomechanics, load distribution, and stability. Recent studies have shown that preserving the meniscus during ACL reconstruction is vital for preventing early onset osteoarthritis and maintaining knee stability. In fact, meniscus repair has been associated with better long-term outcomes compared to meniscectomy.

Surgical Techniques for Combined ACL and Meniscus Repair

Several approaches exist for addressing both ACL and meniscus injuries simultaneously:

1. All-inside meniscus repair with ACL reconstruction
2. Inside-out meniscus repair technique
3. Arthroscopic partial meniscectomy (when repair is not feasible)

Research has shown that arthroscopic all-inside repair using modern systems can achieve high success rates when performed concurrently with ACL reconstruction.

Outcomes of Combined Procedures

Studies have demonstrated favorable outcomes for combined ACL reconstruction and meniscus repair:

• Higher rates of meniscal healing when performed with ACL reconstruction
• Improved knee stability compared to isolated procedures
• Reduced risk of post-traumatic osteoarthritis

One study found that 93.3% of patients who underwent combined ACL reconstruction and meniscus repair returned to their preinjury sport activity level, compared to only 40% in the meniscectomy group.

Factors Influencing Meniscus Repair Success

Several factors can impact the success of meniscus repair in the context of ACL reconstruction:

• Patient age (younger patients tend to have better outcomes)
• Tear location (peripheral tears have higher healing rates)
• Timing of surgery (acute repairs may have advantages)
• Surgeon experience and case volume

A large community-based study found that surgeons with sports medicine fellowship training and higher case volumes were more likely to perform meniscus repairs during ACL reconstruction.

Rehabilitation Considerations

Post-operative rehabilitation for combined ACL and meniscus surgery requires a delicate balance between protecting the repair and preventing stiffness. Most modern protocols allow for:

• Early range of motion exercises
• Gradual weight-bearing progression
• Delayed return to pivoting sports

Research has shown that immediate post-operative range of motion and early weight-bearing do not negatively impact meniscal healing when combined with ACL reconstruction.

Conclusion

Combined ACL reconstruction and meniscus repair offers the best chance for optimal knee function and longevity. By preserving the meniscus whenever possible, surgeons can help patients maintain knee stability, prevent early osteoarthritis, and return to their desired activity levels. As surgical techniques and rehabilitation protocols continue to evolve, outcomes for these complex injuries are likely to improve further.