Arthroscopy - 2026-08-30 - Journal Article
Meniscal Repairs Performed With Posterior Cruciate Ligament Reconstruction Are Associated With Lower Failure Rates Than Isolated Repairs.
Varady NH, Parise S, Ranawat AS, Williams RJ
Topics
Key Takeaway
Meniscal repair performed with PCL reconstruction carries a 2-year failure rate of 4.1% versus 8.4% for isolated repair (adjusted HR 0.41), an effect size comparable to concomitant ACL reconstruction.
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Summary
This study used the PearlDiver insurance database to compare 2-year meniscal repair failure rates between isolated PCLR+MR, MR alone, and ACLR+MR cohorts. PCLR+MR yielded a 59% reduction in adjusted failure risk versus MR alone (HR 0.41, p=0.01) and a 60% reduction in revision or conversion to arthroplasty (HR 0.40, p=0.01). No statistically significant difference in failure rate was found between PCLR+MR and ACLR+MR (adjusted HR 0.64, p=0.21), suggesting ligament reconstruction confers a class effect on meniscal healing.
Key Limitation
The PCLR+MR cohort comprises only 192 patients (0.9% of the total), limiting statistical power for subgroup analyses and raising the possibility of unmeasured selection bias toward lower-energy or more stable PCL injury patterns in that group.
Original Abstract
PURPOSE
To assess the incidence of meniscal repair (MR) failure after posterior cruciate ligament reconstruction (PCLR) + MR compared with MR alone.
METHODS
Patients undergoing isolated PCLR + MR or MR alone were identified from a large insurance database (PearlDiver). A cohort of isolated ACLR + MR was also developed to provide reference data. Demographic, surgical, and comorbidity data were collected and controlled for. The primary outcome was ipsilateral repair failure defined as revision meniscal surgery at 2 years. Secondary outcomes included ipsilateral revision or conversion arthroplasty (RoA). Time-to-event analyses were used to compare outcomes between groups.
RESULTS
There were 21,358 patients (0.9% PCLR + MR, 99.1% MR alone) with a mean follow-up of 3.1 ± 2.1 years. Compared with patients who underwent MR alone, patients who underwent PCLR + MR had significantly lower meniscal failure (unadjusted: 4.1% vs 8.4%, P = .04; adjusted hazard ratio [HR]: 0.41 [0.20-0.82], P = .01) and RoA (unadjusted: 4.1% vs 8.7%, P = .03; adjusted HR: 0.40 [0.20-0.80], P = .01) rates at 2 years. For reference, compared with MR alone, a similar improvement in failure rates was seen with concomitant ACLR + MR (unadjusted: 5.6% vs 8.4%, P < .001; adjusted HR: 0.61 [0.57-0.66], P < .001), whereas there was no difference between PCLR + MR and ACLR + MR (unadjusted: 4.1% vs 5.6%, P = .40; adjusted HR: 0.64 [0.32-1.29], P = .21).
CONCLUSIONS
MRs performed concomitantly with PCLR were associated with significantly lower failure rates compared with isolated MRs, with an effect size comparable to that of ACLR + MR.
LEVEL OF EVIDENCE
Level III, retrospective comparative cohort study.