Long‐term survivorship of medial meniscus posterior horn repair during revision anterior cruciate ligament reconstruction: 10‐year results from the SANTI Group

PURPOSE: To evaluate the long-term rate of secondary medial meniscectomy following medial meniscus posterior horn repair performed during revision anterior cruciate ligament reconstruction (ACLR) and to compare contemporary posteromedial suture-hook repair with other repair strategies used during the study period. We hypothesized that suture-hook repair would be associated with improved long-term meniscal survivorship compared to other repair strategies performed with revision ACLR. METHODS: This retrospective cohort study included patients undergoing revision anterior cruciate ligament reconstruction (rACLR) between 2003 and 2023 at a single high-volume centre. Knees presenting with ramp lesions, meniscocapsular separations, meniscotibial disruptions and longitudinal vertical tears extending into the posterior horn of the medial meniscus treated by repair were identified and stratified according to repair strategy: contemporary posteromedial suture-hook repair versus other techniques used during the study period, including all-inside, inside-out and earlier repair techniques. The primary outcome was secondary medial meniscectomy. Time-to-event analysis was performed using Kaplan-Meier survival estimates and compared using the log-rank test. A multivariable Cox proportional hazards model was used to assess independent predictors of secondary medial meniscectomy, with administrative censoring at 10 years. RESULTS: A total of 402 medial meniscus repairs were included, with a mean follow-up of 96.0 ± 31.4 months after administrative censoring at 10 years. At 10 years, the cumulative rate of secondary medial meniscectomy was 17.5% (95% confidence interval [CI] 13.6-22.4). Unadjusted analysis demonstrated a lower rate of secondary medial meniscectomy in the suture-hook repair group compared with other repair techniques used during the study period (15.8% [95% CI 11.3-21.9] vs. 24.1% [95% CI 16.3-34.9]; log-rank p = 0.0499). However, after multivariable adjustment, repair technique was not independently associated with secondary medial meniscectomy (hazard ratio 1.62, 95% CI 0.90-2.83; p = 0.0986). CONCLUSION: Long-term outcomes of medial meniscus posterior horn repair during rACLR showed a 17.5% cumulative rate of secondary medial meniscectomy at 10 years. Posteromedial suture-hook repair was associated with lower failure rates than other repair techniques on unadjusted analysis; however, repair technique was not an independent predictor of secondary medial meniscectomy after multivariable adjustment. These findings support meniscal preservation and systematic assessment of posteromedial meniscal lesions during revision ACLR while providing realistic long-term expectations regarding repair survivorship. LEVEL OF EVIDENCE: Level III, retrospective cohort study.