Effect of Meniscal Treatment on Functional Outcomes 6 Months After Anterior Cruciate Ligament Reconstruction

Abstract

Background: Meniscal injuries are commonly associated with anterior cruciate ligament (ACL) tears. Treatment of meniscal injuries can impart delayed weightbearing and range of motion restrictions, which can affect the rehabilitation protocol. The effect of meniscal treatment and subsequent restrictions on strength recovery after ACL reconstruction is unclear. Purpose/Hypothesis: The purpose of this study was to compare strength, jumping performance, and patient-reported outcomes between patients who underwent isolated ACL reconstruction (ACLR) and those who underwent surgical intervention for meniscal pathology at the time of ACLR. Our hypothesis was that patients who underwent concurrent meniscal repair (MR) would have lower strength recovery owing to postoperative restrictions. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with ACLR were stratified into isolated ACLR, ACLR and meniscectomy (ACLR-MS), or ACLR-MR groups and were compared with healthy controls. The ACLR-MR group was restricted to partial weightbearing and to 90° of knee flexion for the first 6 weeks postoperatively. All participants completed patient-reported outcomes (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]) and underwent bilateral isokinetic and isometric strength tests of the knee extensor and flexor groups as part of a return-to-sports test battery at 5 to 7 months postoperatively. Results: A total of 165 patients with ACLR (50 with isolated ACLR, 44 with ACLR-MS, and 71 with ACLR-MR) and 140 healthy controls were included in the study. Follow-up occurred at a mean of 5.96 ± 0.47 months postoperatively. The control group demonstrated higher subjective knee function, unilateral peak extensor torque, and limb symmetry than did the ACLR-MS and ACLR-MR groups combined ( P < .001 for all). There were no differences in IKDC, KOOS subscales, or unilateral or limb symmetry measures of peak knee extensor or flexor torque among the isolated ACLR, ACLR-MS, and ACLR-MR groups. Conclusion: Persistent weakness, asymmetry, and reduced subjective outcome scores at 6-month follow-up after ACLR were not influenced by meniscal treatment. These findings suggested that the weightbearing and range of motion restrictions associated with meniscal repair recovery do not result in loss of early strength or worse patient-reported outcomes.