Meniscal hypermobility does not impair functional outcomes after anterior cruciate ligament reconstruction: A retrospective cohort study.

Abstract

Meniscal hypermobility (MH), particularly hypermobile lateral meniscus (HLM), is increasingly recognized as a contributor to knee instability in the setting of anterior cruciate ligament (ACL) rupture. However, its influence on functional outcomes after ACL reconstruction remains unclear. This study aimed to determine whether MH affects clinical recovery and to evaluate the effectiveness of simultaneous ACL reconstruction and Forkel's single-tunnel meniscal root repair. A retrospective cohort study was conducted including 375 patients selected from 1200 ACL reconstructions performed between 2018 and 2023. Patients were allocated into two groups: the case group (n = 159), with ACL rupture and intraoperatively confirmed HLM, and control group (n = 216), with isolated ACL rupture. All patients underwent ACL reconstruction with a modified transtibial hamstring technique; in the case group, a concomitant posterior lateral meniscal root (PLMR) repair was performed using the Forkel single-tunnel method. Functional outcomes were assessed with the International Knee Documentation Committee (IKDC) subjective score preoperatively and at 3, 6, and 12 months. Clinical symptoms (posterolateral pain, hyperflexion pain, and subjective instability) were also recorded. Statistical significance was set at p < 0.05. Both groups demonstrated significant improvement in IKDC scores over time (p < 0.001). In the case group, scores increased from 60.0 ± 7.8 preoperatively to 93.0 ± 4.5 at 12 months, while the control group improved from 60.1 ± 8.1 to 92.0 ± 4.8. No statistically significant differences were observed between groups at any time point (3 months, p = 0.26; 6 months, p = 0.44; 12 months, p = 0.28). Preoperatively, the case group showed a higher prevalence of posterolateral pain (68 % vs. 20 %, p < 0.001) and hyperflexion pain (72 % vs. 35 %, p < 0.001). At 12 months, symptoms had resolved in >80% of patients across both groups, with no differences between cohorts (posterolateral pain, p = 0.21; instability, p = 0.33). MH does not compromise functional recovery when addressed during ACL reconstruction using the Forkel single-tunnel technique. This approach provides an anatomically sound, reproducible, and clinically effective option for treating combined ACL and meniscal pathology. III.