Title : Modifiable predictors of meniscal repair failure following concomitant ACL reconstruction: The role of surgical delay and weight-bearing progression
Abstract:
Background: Meniscal tears occur in up to 65% of acute ACL injuries and repair with concomitant ACL reconstruction (ACLR) is increasingly favoured to prevent meniscal and joint degeneration. Despite reported failure rates of 10–25%, the influence of risk factors, particularly modifiable ones including surgical timing and postoperative weight-bearing progression, remains incompletely defined.
Methods: A retrospective multicenter cohort study included 65 patients undergoing primary ACLR with concomitant meniscal repair (March 2016–March 2025) at King Hamad University Hospital and Royal Medical Services, Bahrain. The primary outcome was symptomatic meniscal retear requiring reoperation or confirmed by imaging alone. Kaplan–Meier survival analysis and Cox proportional hazards regression were used to identify predictors of repair failure across patient, injury, surgical, and rehabilitation variables.
Results: Symptomatic retear occurred in 12 patients (18.5%), with failures clustering within the first 18 months. Bicompartmental (medial + lateral) tears were the strongest independent predictor of failure (HR 12.41, 95% CI 3.51–43.87, p<0.001). Two modifiable timing factors were independently associated with retear in multivariable analysis: Earlier progression to full weight-bearing (HR 0.64 per additional week, 95% CI 0.44–0.94, p=0.023), and longer injury-to-surgery interval (HR 1.02 per week, 95% CI 1.00–1.05, p=0.045). Age, BMI, graft type, repair technique, number of sutures, and early range of motion were not significantly associated with failure.
Conclusion: This multicenter cohort demonstrates that bicompartmental tears and two modifiable timing variables, delayed surgery and premature weight-bearing, independently increase the risk of meniscal repair failure after ACLR. These findings advocate for expedited surgical stabilisation in ACL-injured knees and more protective postoperative loading protocols, particularly in high-risk populations, and warrant prospective validation in larger registries.
