Meniscal Repair Achieves Comparable Mid‐Term Functional Performance to Partial Meniscectomy Following Anterior Cruciate Ligament Reconstruction in Highly Active Patients

ABSTRACT Objective Concomitant meniscal injuries accompany 40%–60% of anterior cruciate ligament (ACL) ruptures. Surgeons often face a clinical choice between meniscal repair, which prioritizes long‐term joint preservation, and partial meniscectomy, which is traditionally perceived to facilitate earlier functional recovery. Despite the biological advantages of repair, persistent concerns remain that its restrictive postoperative protocols might impede mid‐term functional performance compared to meniscectomy. This study aims to compare quadriceps/hamstring strength, dynamic balance, functional hop performance, and patient‐reported outcomes (PROMs) at 2–5 years post‐ACLR between patients undergoing concomitant meniscal repair versus partial meniscectomy. Methods This retrospective cohort study evaluated highly active patients who underwent ACLR between 2019 and 2023. Of 68 patients who underwent ACLR with a concomitant meniscal injury and a pre‐injury Tegner score ≥ 6,16 were excluded: 5 due to revision ACLR or secondary meniscal procedures during the follow‐up period, 8 due to concurrent multi‐ligament injuries or full‐thickness articular cartilage defects requiring surgery, and 3 due to knee joint deformities (varus or valgus malalignment > 5°)The remaining 52 patients were stratified into meniscal repair ( n = 20) or partial meniscectomy ( n = 32) groups. Outcomes included isokinetic strength (60°/s, 180°/s; Limb Symmetry Index, LSI), Y‐balance test, single‐leg hop (SLH), and PROMs (IKDC, Lysholm, and ACL‐RSI). Results At mid‐term follow‐up (mean 4.1 ± 1.2 years for repair, 4.2 ± 1.2 years for meniscectomy; p = 0.59), no significant differences existed in strength (quadriceps/hamstring LSI 60°/s and 180°/s), dynamic balance (Y‐balance), hop tests (SLH, SLCH, and SLTH), or PROMs (all p > 0.05). Conclusion At mid‐term follow‐up (2–5 years), concomitant meniscal repair yielded objective functional performance and patient‐reported outcomes equivalent to partial meniscectomy in highly active patients undergoing ACLR, despite more restrictive early rehabilitation. These findings indicate that the initial postoperative restrictions associated with repair do not result in persistent functional deficits. Although meniscal preservation confers established long‐term chondroprotective advantages, the present analysis addresses functional parity only; the surgical strategy should weigh both mid‐term function and long‐term joint health on an individual basis.