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I injured my knee in a high-school football game and finally had surgery to repair both the ACL and the meniscus. Although I put it off until after college, the surgeon felt sure the delay would not affect the results because I was in such good shape. Now five years down the road, the meniscus has torn again and I wasn't even doing anything when it happened. Was I sold a bill of goods? Rehab after the ACL repair was a lot more (cost and time) than if I had just done the meniscus repair. I'm feeling pretty resentful right now.

The meniscus is a very important structure in providing the knee with normal function. It also helps prevent damage to the joint surface and degenerative arthritis. And until very recently, it was believed that meniscal healing was more likely if the ACL injury was also repaired. Short-term results suggested that better blood flow caused by the ACL reconstruction and alignment of the meniscus with the ACL meant a lower chance of failed surgery. But we now know there is a 24 per cent failure rate for meniscal repairs five years after the operation. This is true whether you have a medial or lateral repair. The rates are the same if you have an intact or damaged anterior cruciate ligament (ACL). And the five-year outcomes are the same if the damaged ACL is repaired or reconstructed. These are the results of a systematic literature review and meta-analysis conducted by researchers at the Washington University School of Medicine in St. Louis. The study was done by the Sports Division of their Department of Orthopaedic Surgery. By pooling the data from 13 high-quality studies, the authors were able to provide a five-year perspective for the modern arthroscopic repairs used most often. Although they hypothesized and hoped that short-term results (after two years) that were previously reported would be maintained long-term, that was not the actual fact. Instead, nearly one-fourth of all patients continued to experience mechanical symptoms (knee pain, clicking, locking) or recurrent tears requiring additional surgery. This large failure rate was consistent for open surgery as well as arthroscopic procedures (using all types of surgical repair techniques). The rate was similar no matter what type of rehab program was used (nonweight-bearing for four weeks, early weight-bearing, early range, of motion, or immobilization with cast, splint, or brace). The authors did not offer any suggestions or reasons why the failure rate following meniscal repairs is so high. This is one of the first studies to take a look at medium-term outcomes with the more modern arthroscopic approaches to meniscal repairs. The 24 per cent failure rate was consistent across all studies no matter what variables were analyzed. Most of the failures developed after two years post-operatively. Data on results past five years is not available yet. So, despite what are considered improved surgical techniques, long-term results are not improved. Further studies are needed to resolve this issue. It would seem that you were given the best evidence-based advice available at the time. That doesn't change your circumstances but may help explain the recommendations and treatment you received.

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