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      The effect of meniscal repair on strength deficits 6 months after ACL reconstruction

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          Abstract

          Introduction

          Ruptures of the anterior cruciate ligament (ACL) can be accompanied by meniscal lesions. Generally, the rehabilitation protocols are altered by meniscal repair. Therefore, the aim of this study was to investigate the effect of meniscal repair on the early recovery of thigh muscle strength in ACL reconstruction (ACLR).

          Materials and methods

          We performed a matched cohort analysis of n = 122 isolated ACLR (CON) compared to n = 61 ACLR with meniscal repair (ACLR + MR). The subgroups of meniscal repair consisted of 30 patients who had undergone medial meniscus repairs (MM), 19 lateral meniscus repairs (LM) and 12 repairs of medial and lateral meniscus (BM). Isokinetic strength measurement was performed pre-operatively and 6 months post-surgery to perform a cross-sectional and a longitudinal analysis. All injuries were unilateral, and the outcome measures were compared to the non-affected contralateral leg.

          Results

          Six months postoperatively overall there is no significant difference between the groups (extension strength MR 82% vs. CON 85% and flexion strength 86% vs. 88%, resp.). Subgroup analysis showed that medial repairs exhibit a comparable leg symmetry while lateral repairs performed worse with leg symmetry being 76% in extension and 81% in flexion strength. Patients undergoing BM repair performed in between lateral and medial repairs (82% extension, 86% flexion).

          Conclusion

          Generally, meniscal repair in conjunction with ACLR does not significantly alter the recovery of limb symmetry in strength at 6 months postoperatively. Interestingly, medial repairs seem to perform superior to lateral meniscal repair and repair of both menisci. Since the recovery of symmetric strength is a major factor in rehabilitation testing, these results will help to advise surgeons on appropriate rehabilitation protocols and setting realistic goals for the injured athlete.

          Level of evidence

          III, retrospective cohort study.

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          Most cited references40

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          Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play.

          Clare L. Ardern, Kate E. Webster, Nicholas F Taylor … (2011)
          An athlete's intention to return to sport following anterior cruciate ligament (ACL) injury is a major indication for surgical intervention. The purpose of this review was to determine postoperative return-to-sport outcomes after ACL reconstruction surgery. Meta-analysis and systematic review Electronic databases including Medline, Embase, SPORTDiscus and CINAHL were searched from the earliest possible entry to April 2010. Studies were included that reported the number of patients returning to sports participation following ACL reconstruction surgery. The results were presented using the World Health Organization's International Classification of Functioning, Disability and Health as a framework and combined using proportion meta-analyses. Forty-eight studies evaluating 5770 participants at a mean follow-up of 41.5 months were included for review. Overall, 82% of participants had returned to some kind of sports participation, 63% had returned to their preinjury level of participation, and 44% had returned to competitive sport at final follow-up. Approximately 90% of participants achieved normal or nearly normal knee function when assessed postoperatively using impairment-based outcomes such as laxity and strength, and 85% when using activity-based outcomes such as the International Knee Documentation Committee knee evaluation form. Fear of reinjury was the most common reason cited for a postoperative reduction in or cessation of sports participation. The relatively low rate of return to competitive sport despite the high rates of successful outcome in terms of knee impairment-based function suggests that other factors such as psychological factors may be contributing to return-to-sport outcomes.
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            Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction.

            Sue D Barber-Westin, Frank R. Noyes (2011)
            Anterior cruciate ligament (ACL) reconstruction is commonly performed in athletes, with the goal of return to sports activities. Unfortunately, this operation may fail, and the rates of either reinjuring an ACL-reconstructed knee or sustaining an ACL rupture to the contralateral knee range from 3% to 49%. One problem that exists is a lack of information and consensus regarding the appropriate criteria for releasing patients to unrestricted sports activities postoperatively. The purpose of this study was to determine the published criteria used to allow athletes to return to unrestricted sports activities after ACL reconstruction. A systematic search was performed to identify the factors investigators used to determine when return to athletics was allowed after primary ACL reconstruction. Inclusion criteria were English language, publication within the last 10 years, clinical trial, all adult patients, primary ACL reconstruction, original research investigation, and minimum 12 months' follow-up. Of 716 studies identified, 264 met the inclusion criteria. Of these, 105 (40%) failed to provide any criteria for return to sports after ACL reconstruction. In 84 studies (32%) the amount of time postoperatively was the only criterion provided. In 40 studies (15%) the amount of time along with subjective criteria were given. Only 35 studies (13%) noted objective criteria required for return to athletics. These criteria included muscle strength or thigh circumference (28 studies), general knee examination (15 studies), single-leg hop tests (10 studies), Lachman rating (1 study), and validated questionnaires (1 study). The results of this systematic review show noteworthy problems and a lack of objective assessment before release to unrestricted sports activities. General recommendations are made for quantification of muscle strength, stability, neuromuscular control, and function in patients who desire to return to athletics after ACL reconstruction, with acknowledgment of the need for continued research in this area. Level IV, systematic review of Level I to IV studies. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
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              Preoperative quadriceps strength is a significant predictor of knee function two years after anterior cruciate ligament reconstruction.

              M Risberg, Pål I. Holm, I Eitzen (2009)
              To identify preoperative predictive factors for knee function two years after reconstructive surgery of the anterior cruciate ligament (ACL). The main hypothesis was that preoperative quadriceps strength would be the most significant predictor for knee function two years after reconstructive surgery. Cohort study. ACL injured individuals treated at a University Hospital and an outpatient clinic in Oslo, Norway. Seventy-three individuals with complete unilateral rupture of the ACL scheduled for reconstruction with a bone-patellar-bone autograft were included in the study, from where 60 were available for two-year follow up and included in the final analyses. Not applicable. Identification of baseline independent variables that may predict knee function assessed with the Cincinnati Knee Score as dependent variable two years after ACL reconstruction. Quadriceps muscle strength, meniscus injury and the Short-Form-36 Bodily Pain sub score were identified as significant predictors for knee function assessed from the Cincinnati Knee Score two years after ACL reconstruction. Individuals with preoperative quadriceps strength deficits above 20% also had persistent significantly larger strength deficits two years after surgery. Preoperative quadriceps muscle strength deficits and meniscus injuries have significant negative consequences for the long-term functional outcome after ACL reconstruction. From our findings we suggest that ACL reconstruction should not be performed before quadriceps muscle strength deficits of the injured limb is less than 20% of the uninjured limb.
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                Author and article information

                Contributors
                M. Wenning:
                ORCID: http://orcid.org/0000-0002-3929-2317
                research@rennbahnklinik.ch
                Journal
                Journal ID (nlm-ta): Arch Orthop Trauma Surg
                Journal ID (iso-abbrev): Arch Orthop Trauma Surg
                Title: Archives of Orthopaedic and Trauma Surgery
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0936-8051
                ISSN (Electronic): 1434-3916
                Publication date (Electronic): 29 January 2020
                Publication date PMC-release: 29 January 2020
                Publication date (Print): 2020
                Volume: 140
                Issue: 6
                Pages: 751-760
                Affiliations
                [1 ]Praxisklinik Rennbahn AG, Kriegackerstraße 100, 4132 Muttenz, Basel Switzerland
                [2 ]GRID grid.5963.9, Department of Orthopedic and Trauma Surgery, Medical Center - University of Freiburg, Faculty of Medicine, , University of Freiburg, ; Hugstetter Str. 55, Freiburg, 79106 Germany
                [3 ]GRID grid.5963.9, Department of Sport and Sport Science, , University of Freiburg, ; Schwarzwaldstr. 175, Freiburg, 79117 Germany
                [4 ]GRID grid.13097.3c, ISNI 0000 0001 2322 6764, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, , King’s College London, ; London, United Kingdom
                Author information
                http://orcid.org/0000-0002-3929-2317
                Article
                Publisher ID: 3347
                DOI: 10.1007/s00402-020-03347-0
                PMC ID: 7244600
                PubMed ID: 31996981
                SO-VID: 383fd597-e9b7-43c6-912c-ac43a6e3048b
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 12 June 2019
                Categories
                Subject: Arthroscopy and Sports Medicine
                Custom metadata
                issue-copyright-statement © Springer-Verlag GmbH Germany, part of Springer Nature 2020

                ScienceOpen disciplines: Orthopedics
                Keywords: acl reconstruction,meniscal repair,performance testing,return to sports,isokinetic strength
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: acl reconstruction, meniscal repair, performance testing, return to sports, isokinetic strength

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