Anterior cruciate ligament reconstruction with concomitant all-inside lateral meniscus posterior root repair shows comparable graft survivorship and clinical outcomes to isolated ACL reconstruction.

PURPOSE: To compare anterior cruciate ligament (ACL) graft survivorship and clinical outcomes after isolated anterior cruciate ligament reconstruction (ACLR) versus ACLR combined with all-inside lateral meniscus posterior root (LMPR) repair. METHODS: This single-centre, single-surgeon retrospective comparative cohort study included consecutive patients undergoing ACLR between January 2017 and December 2023 with a minimum 24-month follow-up. Patients underwent isolated ACLR or ACLR with all-inside LMPR repair according to intraoperative findings. A standardised anatomic single-bundle ACLR with a three-strand pedicled hamstring tendon autograft was used in all cases. The primary endpoint was graft rerupture-free survival. Secondary endpoints included return to sport (RTS), return to work (RTW), contralateral ACL rupture and simple knee value (SKV) at 12 months. Survival was assessed using Kaplan-Meier estimates and adjusted Cox regression. RESULTS: Overall, 841 knees were analysed: 786 isolated ACLR and 55 ACLR + LMPR repair, with a median follow-up of 46.0 months. ACL graft rerupture occurred in 41 isolated ACLR patients and 5 ACLR + LMPR repair patients (5.2% vs. 9.1%; p = 0.216), with no significant difference in graft rerupture-free survival (log-rank p = 0.209). In adjusted Cox analysis, ACLR + LMPR repair was not independently associated with graft rerupture-free survival (hazard ratio [HR] 1.5; 95% confidence interval [CI] 0.6-3.9; p = 0.407), whereas professional athlete status increased rerupture risk (HR 2.8; 95% CI 1.3-6.1; p = 0.010). Contralateral ACL rupture, RTS, RTW and postoperative SKV were comparable between groups. CONCLUSIONS: Concomitant all-inside LMPR repair during ACLR was not independently associated with decreased graft rerupture-free survival and showed comparable clinical outcomes to isolated ACLR at short- to mid-term follow-up. LEVEL OF EVIDENCE: Level III, retrospective comparative cohort study.