Lateral meniscus posterior root repair during ACL reconstruction restores knee stability and results in outcomes comparable to isolated ACL reconstruction: A propensity‐matched cohort analysis

Purpose: To compare clinical and MRI outcomes as well as knee anterior-posterior (AP) and rotational stability between ACL reconstructions (ACLR) with concomitant lateral meniscus posterior root (LMPR) repair and matched isolated ACLR, while assessing whether different LMPR tear patterns affect post-operative stability, healing or meniscal extrusion. Methods: A retrospective review was performed on patients < 55 years old who underwent ACLR and LMPR repair between 2018 and 2022, with minimum 2-year follow-up. Patients with osteoarthritis, prior meniscal or cartilage surgery, revision ACLR, or multi-ligament injuries were excluded. The LMPR group was stratified into oblique radial (I), longitudinal/T-type (II), and avulsion (III) tears. A 2:1 propensity score-matched control cohort of isolated ACLR was created. Pre- and post-operative knee stability (pivot shift, KT-1000), PROMs (IKDC, Lysholm, Tegner), LMPR healing, lateral meniscus extrusion (LME), and MRI parameters (posterior meniscofemoral ligament) pMFL, (lateral femoral notch sign) LFNS were analysed. Results: > 0.05). Conclusion: LMPR repair performed during ACLR successfully restores knee stability, decreases LME, and achieves functional outcomes similar to isolated ACLR. Tear morphology does not significantly affect post-operative clinical or magnetic resonance imaging results. Level of Evidence: Level III, retrospective comparative study.