Effects of meniscal and articular surface status on knee stability,function, and symptoms after anterior cruciate ligament reconstruction: a long-term prospective study

BACKGROUND: Concomitant injuries to secondary structures have been proposed as a major cause of failure of anterior cruciate ligament reconstruction. PURPOSE: Our purpose was to determine the relationship between meniscal status at the time of anterior cruciate ligament reconstruction and ultimate long-term function and stability. STUDY DESIGN: Prospective cohort study. METHODS: We prospectively studied 63 patients for an average of 10.4 years after arthroscopically assisted bone-patellar tendon-bone anterior cruciate reconstruction. All surgeries were performed between 1988 and 1991; concomitant meniscal surgery was performed if necessary. Subjects were divided into subgroups relative to the integrity of their menisci at the end of the reconstruction procedure (intact meniscus, partial meniscectomy, complete meniscectomy). RESULTS: Patients who had undergone any degree of meniscal resection reported significantly more subjective complaints and activity limitations than those with intact menisci. Subjective International Knee Documentation Committee and Lysholm scores were lower in the meniscectomy subgroups than in the meniscus-intact group. Objective testing revealed a significantly lower ability to perform the single-legged hop in the meniscectomy subgroups. Ligament stability based on instrumented laxity measurements was not significantly different between the subgroups. Radiographic abnormalities were also more common in the subgroups that had undergone meniscectomy. CONCLUSIONS: The menisci should be repaired if at all possible, especially in the setting of anterior cruciate ligament reconstruction, for optimal functional outcome and patient satisfaction.