P0827 - Concomitant Meniscectomy Results in Reduced Return To Sport Compared To Meniscus Repair In Primary Pediatric ACL Reconstruction

Background/Purpose: Meniscus repair has demonstrated favorable outcomes when performed concurrently with ACL reconstruction (ACLR). However, the literature comparing meniscal tear patterns, treatments, and outcomes among pediatric patients remains limited. The primary aim of this study is to evaluate the impact of surgical technique on patient outcomes, in primary pediatric ACLR with associated meniscal pathology. We secondarily examined patient factors and tear characteristics on these outcomes. We hypothesized that meniscal repair would result in more favorable outcomes than meniscectomy.

Methods: This is a retrospective cohort study from 01/2014-05/2016 of primary pediatric (≤18 years old) ACL reconstruction patients who underwent concurrent surgical management of a meniscus tear. Predictors studied included patient demographics, injury mechanism, meniscal tear characteristics and surgical treatments. Clinical outcomes including return to sport (RTS), meniscus or ACL graft re-tear, and all cause return to surgery were assessed via patient cross-sectional survey. Criteria for RTS were based on standardized post-operative rehabilitation protocols with functional testing. Univariate and multivariate analyses were used to examine the relationship between studied predictors with the likelihood of RTS and other studied outcomes.

Results: Inclusion criteria were met by 123 patients (120 who reported pre-surgical sport participation) with an average follow-up time of 2.5 ± 0.7 years. RTS was achieved by 80.8% (97/120) of patients while 17.1% (21/123) of patients had a subsequent knee surgery within the studied timeframe. Univariate analysis of factors associated with successful RTS are shown in Table 1. While patients failing to RTS were showed to have delayed surgical intervention (68.7 vs. 54.6 days, p=0.002) in univariate testing, multivariate analysis identified that patients who underwent meniscectomy were less likely to RTS than those who underwent meniscal repair (OR=2.690, 95% CI 1.044-6.930, p=0.040). Patients with an initial contact mechanism of injury were also demonstrated to be more likely to return to the OR for any reason (OR=13.443, CI 1.736-104.108, p=0.013) in multivariate modeling, but none of the other factors evaluated demonstrated meaningful association with the studied outcomes.

Conclusion: In one of the few large cohorts of pediatric ACL reconstructions with concomitant meniscus surgery, this study adds to our understanding of a potentially modifiable factor (meniscus repair) in the surgical treatment of ACL injury with concaminant meniscus tear. Although no differences were seen in rates of meniscus or graft re-tear when comparing treatments, patients who underwent meniscal repair were more likely to return to sport than patients treated with meniscectomy. While these findings may reflect the quality of the torn meniscal tissue and severity of injury, it further emphasizes the importance of meniscal preservation not just for long term joint quality, but also for short term function in active pediatric patients.