KSSTA - 2026-05-22 - Journal Article
Bucket-handle and medial meniscal tears exhibit higher failure rates after all-inside repair with concomitant ACL reconstruction.
von Essen C, Cristiani R, Rizvanovic D, Wänman J, Stålman A
Topics
Key Takeaway
All-inside meniscal repair during ACLR fails in 12.3% of cases at 3 years, with medial repairs (17.7%) and bucket-handle tears (18.6%) carrying the highest risk and a medial repair HR of 3.08 versus lateral.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study evaluated 3-year failure rates (defined as reoperation) across meniscal tear morphologies in patients undergoing all-inside repair concurrent with ACLR at a single high-volume Swedish center from 2015–2022. Medial repairs failed at 17.7% vs. 5.3% for lateral (HR 3.08, 95% CI 2.03–4.67), bucket-handle tears had the highest morphology-specific failure rate at 18.6%, and female sex independently increased failure risk (HR 1.38, 95% CI 1.02–1.88). Root and radial tears had the lowest failure rates at 6.1% and 5.6%, respectively.
Key Limitation
Reoperation as the sole failure criterion underestimates true repair failure, as patients with recurrent symptoms or imaging-confirmed re-tears who did not undergo reoperation are misclassified as successes.
Original Abstract
PURPOSE
To evaluate failure rates across specific meniscal tear morphologies in patients undergoing all-inside meniscal repair with anterior cruciate ligament reconstruction (ACLR), and to identify factors associated with failure.
METHODS
This retrospective cohort included 1355 patients who underwent all-inside meniscal repair during ACLR between 2015 and 2022 at Capio Artro Clinic, Stockholm, Sweden. Failure was defined as reoperation within 3 years. Tear morphology, meniscal laterality, age and sex were recorded. Kaplan-Meier (KM) analysis assessed survival, and Cox regression identified factors associated with failure.
RESULTS
The 3-year failure rate was 12.3%. Medial repairs failed significantly more than lateral repairs (17.7% vs. 5.3%; p < 0.001) with lower medial survival on KM analysis (log rank p < 0.001). Bucket handle tears had the highest failure rate (18.6%), followed by undersurface (15.6%) and longitudinal tears (11.2%). Root (6.1%) and radial tears (RTs) (5.6%) had the lowest. In multivariable analysis, medial repair was the strongest predictor of failure (hazard ratio [HR] 3.08, 95% confidence interval [CI] 2.03-4.67, p < 0.001). Longitudinal tears had lower failure risk than bucket handle tears (HR 0.67, 95% CI 0.57-0.95, p = 0.03). Female sex increased failure risk (HR 1.38, 95% CI 1.02-1.88, p = 0.03), while age >30 years was not associated with failure.
CONCLUSION
Meniscal repair performed during ACL reconstruction demonstrated a 12.3% failure rate at 3 years. Failure risk differed by tear morphology and meniscal side, with medial repairs and bucket‑handle tears showing the highest risk, while root and RTs showed the lowest. Female sex was independently associated with increased failure, whereas age was not.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.