Surgeon anterior cruciate ligament reconstruction volume and rates of concomitant meniscus repair

Abstract

Abstract Purpose The purpose of this study was to assess the effect of surgeon anterior cruciate ligament reconstruction (ACLR) volume on rates of ACLR with concomitant meniscus repair versus meniscectomy and subsequent meniscus surgeries. Methods A retrospective review was conducted from a database of all ACLR performed between 2015 and 2020 at a large integrated health care system. Surgeon volume was categorized as < 35 ACLR per year (low-volume), and ≥ 35 ACLR per year (high-volume). Rates of concomitant meniscus repair and meniscectomy were compared between low-volume and high-volume surgeons. Subgroup analyses compared the rates of subsequent meniscus surgery and procedure time based on surgeon volume and meniscus procedure type. Results A total of 3,911 patients undergoing ACLR were included. High-volume surgeons performed concomitant meniscus repair statistically significantly more often than low-volume surgeons (32.0% vs 10.7%, p < 0.001). Binary logistic regression indicated 4.15 times higher odds of meniscus repair among high-volume surgeons. Subsequent meniscus surgery occurred more commonly following ACLR with meniscus repair among low-volume surgeons (6.7% vs 3.4%, p = 0.047), but not high-volume surgeons (7.0% vs 4.3%, p = 0.079). Low-volume surgeons also had longer procedure times for concomitant meniscus repair (129.9 vs 118.3 min, p = 0.003) and meniscectomy (100.6 vs 95.9 min, p = 0.003). Conclusions Data from this study shows that surgeons with lower volume of ACLR select meniscus resection statistically significantly more often than higher-volume surgeons. However, an abundance of literature is available to show that meniscus loss negatively affects the development of post-traumatic osteoarthritis in patients Therefore, as demonstrated in this study by high-volume surgeons, the meniscus should be repaired and protected whenever possible. Level of Evidence III.