Similar cartilage outcomes after meniscal repair and resection in anterior cruciate ligament‐reconstructed knees: A registry‐based second‐look arthroscopy study

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Abstract
Purpose: To evaluate whether meniscal repair reduces the risk of cartilage damage compared with meniscal resection in patients undergoing both primary and revision anterior cruciate ligament reconstruction (ACLR). Methods: This registry‐based cohort study included 2845 patients from the Swedish Knee Ligament Register who underwent both primary and revision ACLR between 2005 and 2023. Cartilage status was assessed arthroscopically at both surgeries. Meniscal treatment at primary ACLR was categorized as repair or resection (medial: 168 resections, 299 repairs; lateral: 486 resections, 162 repairs). The primary outcome was the development of new cartilage lesions at revision. Predictors of new cartilage lesions were analysed using multivariate logistic regression. Results: In the medial femoral condyle, new cartilage lesions occurred in 32.3% of patients after resection and 26.5% after repair (odds ratio [OR]: 0.76, 95% confidence interval [CI]: 0.47–1.21). In the medial tibial plateau, new cartilage lesion rates were 13.5% and 14.0%, respectively (OR: 1.04, 95% CI: 0.61–1.79). In the lateral femoral condyle, cartilage lesions occurred in 12.5% after resection and 14.5% after repair (OR: 1.18, 95% CI: 0.67–2.09), while in the lateral tibial plateau, rates were 8.7% and 7.9% (OR: 0.89, 95% CI: 0.43–1.86). No significant differences were found in lesion size or severity between treatment groups in any location. Multivariate analysis showed that older age, longer time to revision and meniscal treatment (both repair and resection) were associated with higher odds of new cartilage lesions (all p <0.05). Time from injury to primary ACLR was not associated with cartilage outcomes. Conclusion: Meniscal repair did not confer a clear chondroprotective advantage compared with resection in ACLR. Both treatment types were associated with new cartilage lesions, suggesting that meniscal injury itself may be a key contributor to cartilage degeneration. Age and time to revision were strong predictors of cartilage damage. Level of Evidence: Level III, retrospective cohort study.

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