Healing results of meniscal tears left in situ during anterior cruciate ligament reconstruction: a review of clinical studies

The presence of peripheral meniscal tears is common at the time of anterior cruciate ligament (ACL) reconstruction. Techniques to preserve the maximum amount of meniscal tissue include non operative management (tear left alone, without repair or removal), meniscus repair, partial meniscectomy. There is a lack of consensus guidelines about the management of peripheral stable meniscal tears. When to remove, let alone or repair? We performed an evidence-based review of the outcomes of stable meniscal tears left in situ during ACL surgery, in order to assess the effectiveness of this popular procedure. Clinical and anatomical results (arthrography or second look arthroscopy) were analyzed. Our literature search yielded ten relevant studies (9 level IV, 1 level III). The mean time of follow-up was 16 months. Pain or mechanical symptoms related to the medial tibiofemoral joint were reported in 0-66% of cases. Subsequent medial meniscectomy or repair were performed in 0-33% of cases. Pain or mechanical symptoms related to the lateral tibiofemoral joint were reported in 0-18% cases. Subsequent lateral meniscectomy or repair were performed in 0-22% cases. A complete healing occurred in 50-61% cases for the medial meniscus and in 55-74% cases for the lateral meniscus. No definite conclusion can be made with regard to these results. The conservative approach is more effective for lateral menisci. The rate of bad results for the medial meniscus remains high when a conservative treatment is used. For the medial meniscus, repair of stable peripheral tears may be always indicated to decrease the risk of postoperative pain or subsequent meniscectomy.