Objective laxity and subjective outcomes are more influenced by meniscal treatment than anterior cruciate ligament reconstruction technique at minimum2 years of follow-up

Abstract

Objective: The purposes of this study were: (1) to compare three different surgical techniques for anterior cruciate ligament (ACL) reconstruction at a minimum 2 years of follow-up in terms of objective laxity and patient-reported outcomes; (2) to inspect the role of meniscal tears and treatment alongside with ACL reconstruction.

Methods: 59 patients were randomly assigned to one of the three reconstruction groups according to the ACL reconstruction technique: Double Bundle, Single Bundle, Single Bundle with Lateral Plasty. Autologous hamstring tendons were used in all the ACL reconstruction techniques. Objective laxity tests and KOOS were collected before surgery as a baseline and at a minimum of 2 years of follow-up and compared through a Repeated measure ANOVA. Secondary analysis to evaluate the effect of meniscal treatment on laxity reduction and scores improvement was also conducted using ANOVA. Three laxity evaluations were performed: anterior/posterior displacement at 30° of knee flexion (AP 30), anterior/posterior displacement at 90° of knee flexion (AP 90), and pivot-shift test.

Results: Objective laxity and KOOS showed statistically significant improvement at follow-up in all three groups (p < 0.0001) without differences among the techniques. A higher AP 30 (mean difference 2.4 mm, p = 0.0333, ES = 0.66) was found at baseline for the patients with irreparable medial meniscal tear compared to the patients with isolated ACL tear; a statistically significant difference in pain score at two-year follow-up was found between patients who underwent lateral meniscectomy and patients with either meniscal repair (mean difference 6.9 ± 12.5) or isolated ACL tear (mean difference 6.8 ± 16.1); patients with reparable meniscal tear had a statistically significant pain score improvement compared to the patients who underwent medial and lateral meniscectomy (mean difference of 9.5 ± 14.53 and 23.4 ± 19.2 respectively).

Conclusion: Comparable objective laxity and subjective outcomes were found among the three ACL reconstruction techniques at a minimum of 2 years of follow-up. The presence of irreparable medial meniscal tear increased pre-operative laxity (AP 30, mean difference 2.4 ± 3.6 mm). Patients with meniscal repair presented higher pain relief between baseline and follow-up compared with patients undergoing medial or lateral meniscectomy (mean difference of 9.5 ± 14.53 and 23.4 ± 19.2, respectively).

Keywords: ACL; Double bundle; Lateral plasty; Laxity; Meniscus; Patient-reported outcomes.