Skip to main content
Journal of Experimental Orthopaedics
Download PDF

Surgeon anterior cruciate ligament reconstruction volume and rates of concomitant meniscus repair

Journal of Experimental Orthopaedics volume 10, Article number: 61 (2023) Cite this article

Abstract

Purpose

The purpose of this study was to assess the effect of surgeon anterior cruciate ligament reconstruction (ACLR) volume on rates of ACLR with concomitant meniscus repair versus meniscectomy and subsequent meniscus surgeries.

Methods

A retrospective review was conducted from a database of all ACLR performed between 2015 and 2020 at a large integrated health care system. Surgeon volume was categorized as < 35 ACLR per year (low-volume), and ≥ 35 ACLR per year (high-volume). Rates of concomitant meniscus repair and meniscectomy were compared between low-volume and high-volume surgeons. Subgroup analyses compared the rates of subsequent meniscus surgery and procedure time based on surgeon volume and meniscus procedure type.

Results

A total of 3,911 patients undergoing ACLR were included. High-volume surgeons performed concomitant meniscus repair statistically significantly more often than low-volume surgeons (32.0% vs 10.7%, p < 0.001). Binary logistic regression indicated 4.15 times higher odds of meniscus repair among high-volume surgeons. Subsequent meniscus surgery occurred more commonly following ACLR with meniscus repair among low-volume surgeons (6.7% vs 3.4%, p = 0.047), but not high-volume surgeons (7.0% vs 4.3%, p = 0.079). Low-volume surgeons also had longer procedure times for concomitant meniscus repair (129.9 vs 118.3 min, p = 0.003) and meniscectomy (100.6 vs 95.9 min, p = 0.003).

Conclusions

Data from this study shows that surgeons with lower volume of ACLR select meniscus resection statistically significantly more often than higher-volume surgeons. However, an abundance of literature is available to show that meniscus loss negatively affects the development of post-traumatic osteoarthritis in patients Therefore, as demonstrated in this study by high-volume surgeons, the meniscus should be repaired and protected whenever possible.

Level of Evidence

III.

Background

Studies have shown an association between increasing surgical volume and improved clinical outcomes. In the total hip arthroplasty literature, increasing surgeon volume is associated with greater implant survivorship, lower complication rates, shorter hospital length of stay, and lower costs [12, 19]. Total knee arthroplasty has similarly shown an association between surgeon volume and complications, revision rates, procedure times, transfusion rates, and patient-reported outcomes [15, 31]. The relationship between surgeon volume and outcomes is also reported in shoulder surgery, where a recent systematic review of 10 studies reported lower volume was associated with increased surgical complications, length of stay, surgical times, and costs [30].

Less is known about the relationship between surgeon anterior cruciate ligament (ACL) reconstruction (ACLR) volume and clinical outcomes. It has been reported that low surgeon ACLR volume is associated with greater operating room time, increased readmission rates, a greater risk of subsequent surgery, and greater costs of adverse events [9, 18]. Additionally, lower surgeon volume has been associated with increased allograft use during ACLR, compared to higher rates of patellar tendon autograft among high-volume surgeons [9]. Finally, high-volume surgeons have been shown to place more anatomic tunnels during ACLR, which may decrease the risk of ACL graft failure and revision ACLR [5, 8].

Concomitant meniscus injury is an important factor to consider in an ACL-deficient knee, as appropriate management of such injuries is crucial in restoring knee stability [25, 29]. Posterior horn medial meniscus tears have been associated with increased anterior tibial translation, while lateral meniscus posterior root tears have been associated with increased rotatory knee instability [1, 26]. Repair of meniscus tears has been shown to not only improve rotatory knee stability [6, 29], but also decrease the risk of post-traumatic osteoarthritis (OA), as meniscectomy has been associated with joint space narrowing and progression of articular cartilage damage after ACLR [10, 21]. As a result, meniscus repair has gained popularity as the primary treatment modality for traumatic meniscus tears in an effort to “save the meniscus” and preserve long-term knee stability and function [3, 24].

The purpose of this study was to assess the effect of surgeon ACLR volume on rates of concomitant meniscus repair versus meniscectomy, as well as subsequent meniscus surgeries. The hypothesis was that low-volume surgeons would perform concomitant meniscus repair less often than higher volume surgeons, and that low-volume surgeons would experience higher rates of subsequent meniscus surgery.

Methods

This retrospective study was granted Institutional Review Board approval at the University of Pittsburgh (No: STUDY19030196). All patients that underwent primary ACLR at a large integrated health care system made up of both academic and community hospitals from January 2015 to December 2020 were identified from a registry database and analyzed for inclusion. Patients undergoing ACLR both with and without meniscus surgery were included. Exclusion criteria included patients < 14 years old, patients undergoing combined meniscus repair and meniscectomy, bilateral procedures at the time of primary ACLR, and multi-ligament reconstruction. The informatics system was queried for all consecutive ACLR cases performed over this time period based on CPT code, and concomitant meniscus surgeries were additionally recorded using CPT codes for meniscectomy and meniscus repair. Data was extracted from the system in January 2023, allowing for minimum 2-year follow-up to assess for subsequent meniscus surgeries.

Data regarding patient age, sex, and body mass index (BMI), as well as performing surgeon, were recorded. Low surgeon volume was defined as performing fewer than 35 ACLR per year, and high surgeon volume defined as performing 35 or more ACLR per year, based on previous literature demonstrating an increased risk for subsequent knee surgery among surgeons performing < 35 ACLR per year [8, 23]. Surgeon yearly ACLR volume was averaged over all active years of practice within the time period of the study to classify each surgeon.

The primary outcome was the rate of concomitant meniscus repair versus meniscectomy performed at the time of primary ACLR, which was compared between low- and high-volume surgeon groups. All patients undergoing meniscus surgery were further evaluated for rates of subsequent meniscus surgeries and primary ACLR procedure time based on surgeon volume and meniscus procedure type (meniscectomy versus meniscus repair).

Statistical analysis was performed using chi-square tests to compare categorical variables, and independent t-tests or Mann–Whitney U tests for parametric and non-parametric continuous variables, respectively, between low-volume and high-volume surgeon groups. Binary logistic regression was performed to calculate odds ratios (OR) and 95% confidence intervals (95% CI) for significant findings. Statistical significance was set at p < 0.05.

Results

Between 2015 and 2020, a total of 4,407 patients underwent primary ACLR. Following application of exclusion criteria, 3,911 patients were included, of which 2,004 patients were operated on by 8 high-volume surgeons and 1,907 patients were operated on by 67 low-volume surgeons (Fig. 1). High-volume surgeons performed an average of 56 ACLR per year, whereas low-volume surgeons performed an average of 7 ACLR per year.

Fig. 1
figure 1

Flowchart of Inclusion and Exclusion Criteria. ACLR = anterior cruciate ligament reconstruction

Full size image

The mean age of patients undergoing ACLR was 26.7 years (SD: 11.6 years; range: 14 to 64 years), and 44.8% of patients were female. The mean BMI of the cohort was 27.5 kg/m2 (SD: 5.9 kg/m2). The mean age of patients in the low-volume surgeon group was significantly higher than the high-volume surgeon group (28.8 vs 24.8 years; p < 0.001). Additionally, patients in the low-volume cohort had a higher BMI than the high-volume cohort (28.4 vs 26.6 kg/m2; p < 0.001) (Table 1). No differences in rates of subsequent meniscus surgeries were identified between surgeon volume groups for the total cohort (Table 1).

Table 1 Patient demographics and rates of subsequent meniscus surgeries based on surgeon volume
Full size table

Among the 3,911 patients included in the study, ACLR with concomitant meniscus repair was performed in 835 cases (21.4%), and ACLR with concomitant meniscectomy was performed in 899 cases (23.0%). Isolated ACLR without meniscus surgery was performed in 2,177 cases (55.7%), and was more prevalent among low-volume surgeons compared to high-volume surgeons (62.7% vs 49.5%; p < 0.001) (Table 2). High-volume surgeons performed concomitant meniscus repair statistically significantly more often (32.0% vs 10.2%; p < 0.001), and concomitant meniscectomy less often (18.6% vs 27.6%; p < 0.001), than low-volume surgeons (Table 2). Binary logistic regression indicated that high-volume surgeons had 4.15 times higher odds of performing meniscus repair versus meniscectomy when compared to low-volume surgeons (OR: 4.15; 95% CI: 3.48–4.95; p < 0.001) (Table 3).

Table 2 Comparison of concomitant meniscus surgery during primary ACLR based on surgeon volume
Full size table
Table 3 Binary logistic regression for meniscus repair versus meniscectomy
Full size table

In the total study population, subsequent meniscus surgery occurred more commonly following ACLR with meniscus repair versus meniscectomy (6.9% vs 3.8%; p = 0.003). However, when stratified based on surgeon volume, the increased rate of subsequent meniscus surgery following meniscus repair versus meniscectomy was apparent among low-volume surgeons (6.7% vs 3.4%, p = 0.047), but not high-volume surgeons (7.0% vs 4.3%, p = 0.079) (Table 4). Additionally, increased procedure times were found in the low-volume surgeon group compared to the high-volume group across all procedure types (106.5 vs 103.2 min; p = 0.002), and when stratified by ACLR with concomitant meniscus repair (129.9 vs 118.8 min; p = 0.003) and meniscectomy (100.6 vs 95.9 min; p = 0.003) (Table 5).

Table 4 Subsequent meniscus surgery based on surgeon volume and meniscus procedure type
Full size table
Table 5 Procedure time based on surgeon volume and meniscus procedure type
Full size table

Discussion

The most important finding of this study was that low-volume surgeons performed ACLR with concomitant meniscus repair at a significantly lower rate than high-volume surgeons. Additionally, concomitant meniscus repair resulted in an increased rate of subsequent meniscus surgery among low-volume surgeons, but not high-volume surgeons. This is one of few studies to assess the impact of surgeon ACLR volume on rates of meniscus repair versus meniscectomy, and uniquely analyzes a large, heterogeneous cohort from both academic and community physicians.

The primary finding of this study was consistent with two previous studies on ACLR surgeon volume [16, 32]. A cross-sectional study of a community-based ACLR registry reported surgeons performing 52 or more ACLR per year were 1.68 times more likely to perform a concomitant meniscus repair than surgeons performing between 6 and 52 ACLR per year, and 2.56 times more likely than surgeons performing fewer than 6 ACLR per year [32]. Another study of a statewide surgical database reported that surgeons performing more than 25 ACLR per year were 1.196 times more likely to perform a concomitant meniscus repair than lower volume surgeons [16]. In contrast, an analysis of the American Board of Orthopaedic Surgeons database from 2003 to 2007 did not find a difference in rates of concomitant meniscus repair between those performing fewer than 5 ACLR per year and more than 26 ACLR per year [20]. Instead, sports medicine fellowship training was associated with performing concomitant meniscus repair as compared to other fellowship training or no fellowship training. Given the conflicting data in the literature, the present study adds a very large sample size that supports prior literature demonstrating an association between higher surgeon ACLR volume and concomitant meniscus repair. Specifically, our study identifies high surgeon ACLR volume as a significant predictor of performing meniscus repair versus meniscectomy, with 4.15 times increased odds when compared to low surgeon ACLR volume. This is a clinically significant finding when considering recent trends that favor meniscus repair over meniscectomy in an effort to preserve the long-term health of the knee joint [2, 14, 28].

In our study, an increased rate of subsequent meniscus surgery was additionally found following meniscus repair versus meniscectomy by low-volume surgeons, but not high-volume surgeons. Previous literature has shown meniscus repair results in higher rates of subsequent meniscus surgery when compared to meniscectomy [11], with a recent systematic review indicating a 19% failure rate up to 6 years following meniscus repair [22]. However, the importance of meniscal repair cannot be understated [3] due to the unfavorable long-term outcomes following meniscectomy versus meniscus repair, such as increased progression of OA (60% versus 20%) and lower return to pre-injury activity level (50% versus 96.2%) at mean 8.8 years follow-up [27]. In addition, more recent literature has demonstrated lower rates of subsequent meniscectomy following meniscus repair, likely due to advances in surgical techniques and devices [17]. Further, in the setting of ACLR, meniscus repair has the potential to limit post-traumatic OA given that meniscectomy with concomitant ACLR has been associated with joint space narrowing and articular cartilage damage [10, 21]. While concomitant ACLR has been shown to be protective with regard to subsequent meniscus surgery following meniscus repair [13], patients treated by high-volume surgeons are at further decreased risk of subsequent knee surgery compared to patients treated by low-volume surgeons [17]. Our findings mirror prior literature demonstrating a higher rate of subsequent meniscus surgery following meniscus repair by a low-volume ACLR surgeon [16, 17], whereas no such finding was apparent amongst high-volume ACLR surgeons in our study.

Finally, an increased procedure time was observed among low-volume surgeons compared to high-volume surgeons in the setting of meniscus repair and meniscectomy. Previous literature has demonstrated that lower volume surgeons have increased primary ACLR procedure times compared to high-volume surgeons, especially in the tendon harvesting phase [7]. It is therefore possible that the increased procedure times among low-volume surgeons in our study were a result of the ACLR procedure as opposed to the meniscus procedure performed. Despite this, there are important adverse effects of prolonged procedure times in the setting of ACLR, and surgeon volume may play an important role based on previous literature [4, 9]. A recent large registry study of 12,077 ACLR found increased procedure time to be independently associated with increased rates of overnight hospital stay, hospital readmission, return to the operating room, and 30-day complication rates [4]. Further, a review of multiple statewide databases showed surgeons performing fewer than 6 ACLR per year had greater operating room times and higher rates of non-routine discharges resulting in increased resource utilization [9]. While the effect of surgeon volume on meniscus procedure times has not been identified in the literature, the increased procedure times observed among low-volume surgeons in our study are an important consideration for patients undergoing ACLR with concomitant meniscus tears.

There are several limitations to the present study. First, as a large registry study, specific data regarding the type, location, and size of concomitant meniscus tears remains unknown, which may impact the decision to perform meniscus repair versus meniscectomy. However, the large sample size of our study increases the likelihood of evenly distributed meniscus tear patterns. Second, there were significant age and BMI differences between the surgeon volume groups, which may have impacted the decision to perform meniscus repair versus meniscectomy, and influenced rates of subsequent meniscus surgery. However, while statistically significant, the clinical difference in these variables was small, and the potential impact of such differences is likely minimal when considering the significant difference in the rates of meniscus repair and meniscectomy between surgeon volume groups. Finally, as a retrospective registry review of a single large healthcare system, patients who sought care outside of our healthcare system were lost to follow-up, which has the potential to confound our results, specifically regarding rates of return meniscus procedures. However, the large sample size of our study again favors the likelihood that loss of follow-up was evenly distributed between surgeon volume groups, and the increased rate of subsequent meniscus surgery following meniscus repair by low-volume surgeons remains an important finding of the study.

The findings of this study suggest that high-volume surgeons perform ACLR with concomitant meniscus repair significantly more often than low-volume surgeons. Our results complement previous literature and provide increased evidence on the relationship between surgeon volume and rates of meniscus repair versus meniscectomy. This data may be utilized by surgeons to highlight differences in care based on surgeon characteristics, in an effort to discover avenues for change and optimize patient outcomes following ACLR with concomitant meniscus pathology.

Conclusions

Low-volume surgeons were observed to perform ACLR with concomitant meniscus repair statistically significantly less often than high-volume surgeons. Further, low-volume surgeons demonstrated a higher rate of subsequent meniscus surgery following meniscus repair versus meniscectomy, whereas no significant difference was found among high-volume surgeons. An abundance of literature is available to show that meniscus loss negatively affects the development of post-traumatic osteoarthritis in patients, and therefore, as demonstrated in this study by high-volume surgeons, the meniscus should be repaired and protected whenever possible.

Availability of data and materials

No publicly available data was used for this study. Data sharing is not applicable to this article.

References

  1. Ahn JH, Bae TS, Kang KS, Kang SY, Lee SH (2011) Longitudinal tear of the medial meniscus posterior horn in the anterior cruciate ligament-deficient knee significantly influences anterior stability. Am J Sports Med 39:2187–2193. https://doi.org/10.1177/0363546511416597

    Article  PubMed  Google Scholar 

  2. Alerskans S, Kostogiannis I, Neuman P (2022) Patient’s subjective knee function 3-5 years following partial meniscectomy or meniscus repair compared to a normal population: a retrospective cohort study. BMJ Open Sport Exerc Med 8:e001278. https://doi.org/10.1136/bmjsem-2021-001278

    Article  PubMed  PubMed Central  Google Scholar 

  3. Beaufils P, Pujol N (2017) Management of traumatic meniscal tear and degenerative meniscal lesions. Save the meniscus. Orthop Traumatol Surg Res 103:S237–S244. https://doi.org/10.1016/j.otsr.2017.08.003

    Article  CAS  PubMed  Google Scholar 

  4. Boddapati V, Fu MC, Nwachukwu BU et al (2020) Procedure length is independently associated with overnight hospital stay and 30-day readmission following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 28:432–438. https://doi.org/10.1007/s00167-019-05622-z

    Article  PubMed  Google Scholar 

  5. Byrne KJ, Hughes JD, Gibbs C et al (2022) Non-anatomic tunnel position increases the risk of revision anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 30:1388–1395. https://doi.org/10.1007/s00167-021-06607-7

    Article  PubMed  Google Scholar 

  6. Forkel P, von Deimling C, Lacheta L et al (2018) Repair of the lateral posterior meniscal root improves stability in an ACL-deficient knee. Knee Surg Sports Traumatol Arthrosc 26:2302–2309. https://doi.org/10.1007/s00167-018-4949-8

    Article  PubMed  Google Scholar 

  7. Harato K, Kobayashi S, Toyoda T, Hasegawa T, Tsukimura Y, Niki Y (2020) technical obstacles for low-volume surgeons in primary anterior cruciate ligament reconstruction. J Knee Surg 33:1238–1242. https://doi.org/10.1055/s-0039-1692674

    Article  PubMed  Google Scholar 

  8. Hughes JD, Gibbs CM, Almast A et al (2022) More anatomic tunnel placement for anterior cruciate ligament reconstruction by surgeons with high volume compared to low volume. Knee Surg Sports Traumatol Arthrosc 30:2014–2019. https://doi.org/10.1007/s00167-022-06875-x

    Article  PubMed  Google Scholar 

  9. Jain N, Pietrobon R, Guller U, Shankar A, Ahluwalia AS, Higgins LD (2005) Effect of provider volume on resource utilization for surgical procedures of the knee. Knee Surg Sports Traumatol Arthrosc 13:302–312. https://doi.org/10.1007/s00167-004-0516-6

    Article  PubMed  Google Scholar 

  10. Jones MH, Spindler KP, Andrish JT et al (2018) Differences in the lateral compartment joint space width after anterior cruciate ligament reconstruction: data from the MOON onsite cohort. Am J Sports Med 46:876–882. https://doi.org/10.1177/0363546517751139

    Article  PubMed  Google Scholar 

  11. Kimura Y, Sasaki E, Yamamoto Y, Sasaki S, Tsuda E, Ishibashi Y (2020) Incidence and risk factors of subsequent meniscal surgery after successful anterior cruciate ligament reconstruction: a retrospective study with a minimum 2-year follow-up. Am J Sports Med 48:3525–3533. https://doi.org/10.1177/0363546520967670

    Article  PubMed  Google Scholar 

  12. Koltsov JCB, Marx RG, Bachner E, McLawhorn AS, Lyman S (2018) Risk-based hospital and surgeon-volume categories for total hip arthroplasty. J Bone Joint Surg Am 100:1203–1208. https://doi.org/10.2106/jbjs.17.00967

    Article  PubMed  Google Scholar 

  13. Korpershoek JV, de Windt TS, Vonk LA, Krych AJ, Saris DBF (2020) Does anterior cruciate ligament reconstruction protect the meniscus and its repair? A systematic review. Orthop J Sports Med 8:2325967120933895. https://doi.org/10.1177/2325967120933895

    Article  PubMed  PubMed Central  Google Scholar 

  14. Krivicich LM, Kunze KN, Parvaresh KC et al (2022) Comparison of long-term radiographic outcomes and rate and time for conversion to total knee arthroplasty between repair and meniscectomy for medial meniscus posterior root tears: a systematic review and meta-analysis. Am J Sports Med 50:2023–2031. https://doi.org/10.1177/03635465211017514

    Article  PubMed  Google Scholar 

  15. Lau RL, Perruccio AV, Gandhi R, Mahomed NN (2012) The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature. BMC Musculoskelet Disord 13:250. https://doi.org/10.1186/1471-2474-13-250

    Article  PubMed  PubMed Central  Google Scholar 

  16. Li LT, Bokshan SL, DeFroda SF, Mehta SR, Fadale PD, Owens BD (2020) High case volume predicts greater odds of autograft use and meniscal repair for anterior cruciate ligament reconstruction. Arthroscopy. https://doi.org/10.1016/j.arthro.2020.08.011

    Article  PubMed  Google Scholar 

  17. Lyman S, Hidaka C, Valdez AS et al (2013) Risk factors for meniscectomy after meniscal repair. Am J Sports Med 41:2772–2778. https://doi.org/10.1177/0363546513503444

    Article  PubMed  Google Scholar 

  18. Lyman S, Koulouvaris P, Sherman S, Do H, Mandl LA, Marx RG (2009) Epidemiology of anterior cruciate ligament reconstruction: trends, readmissions, and subsequent knee surgery. J Bone Joint Surg Am 91:2321–2328. https://doi.org/10.2106/JBJS.H.00539

    Article  PubMed  Google Scholar 

  19. Malik AT, Jain N, Scharschmidt TJ, Li M, Glassman AH, Khan SN (2018) Does surgeon volume affect outcomes following primary total hip arthroplasty? A systematic review. J Arthroplasty 33:3329–3342. https://doi.org/10.1016/j.arth.2018.05.040

    Article  PubMed  Google Scholar 

  20. Musahl V, Jordan SS, Colvin AC, Tranovich MJ, Irrgang JJ, Harner CD (2010) Practice patterns for combined anterior cruciate ligament and meniscal surgery in the United States. Am J Sports Med 38:918–923. https://doi.org/10.1177/0363546509357900

    Article  PubMed  Google Scholar 

  21. Nakamae A, Adachi N, Deie M et al (2018) Risk factors for progression of articular cartilage damage after anatomical anterior cruciate ligament reconstruction: a second-look arthroscopic evaluation. Bone Joint J 100-b:285–293. https://doi.org/10.1302/0301-620x.100b3.bjj-2017-0837.r1

    Article  CAS  PubMed  Google Scholar 

  22. Ow ZGW, Law MSN, Ng CH et al (2021) All-cause failure rates increase with time following meniscal repair despite favorable outcomes: a systematic review and meta-analysis. Arthroscopy 37:3518–3528. https://doi.org/10.1016/j.arthro.2021.05.033

    Article  PubMed  Google Scholar 

  23. Schairer WW, Marx RG, Dempsey B, Ge Y, Lyman S (2017) The relation between volume of reconstruction and future knee surgery orthopaedic. J Sports Med 5:2325967117S00298. https://doi.org/10.1177/2325967117s00298

    Article  Google Scholar 

  24. Seil R, Becker R (2016) Time for a paradigm change in meniscal repair: save the meniscus! Knee Surg Sports Traumatol Arthrosc 24:1421–1423. https://doi.org/10.1007/s00167-016-4127-9

    Article  PubMed  Google Scholar 

  25. Shiwaku K, Kamiya T, Suzuki D et al (2022) The role of the medial meniscus in anterior knee stability. Orthop J Sports Med 10:23259671221132844. https://doi.org/10.1177/23259671221132845

    Article  PubMed  PubMed Central  Google Scholar 

  26. Shybut TB, Vega CE, Haddad J et al (2015) Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 43:905–911. https://doi.org/10.1177/0363546514563910

    Article  PubMed  Google Scholar 

  27. Stein T, Mehling AP, Welsch F, von Eisenhart-Rothe R, Jager A (2010) Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Am J Sports Med 38:1542–1548. https://doi.org/10.1177/0363546510364052

    Article  PubMed  Google Scholar 

  28. Suchman KI, Behery OA, Mai DH, Anil U, Bosco JA (2018) The demographic and geographic trends of meniscal procedures in New York State: an analysis of 649,470 patients over 13 years. J Bone Joint Surg Am 100:1581–1588. https://doi.org/10.2106/JBJS.17.01341

    Article  PubMed  Google Scholar 

  29. Tang X, Marshall B, Wang JH et al (2019) Lateral meniscal posterior root repair with anterior cruciate ligament reconstruction better restores knee stability. Am J Sports Med 47:59–65. https://doi.org/10.1177/0363546518808004

    Article  PubMed  Google Scholar 

  30. Weinheimer KT, Smuin DM, Dhawan A (2017) Patient outcomes as a function of shoulder surgeon volume: a systematic review. Arthroscopy 33:1273–1281. https://doi.org/10.1016/j.arthro.2017.03.005

    Article  PubMed  Google Scholar 

  31. Wilson S, Marx RG, Pan TJ, Lyman S (2016) Meaningful thresholds for the volume-outcome relationship in total knee arthroplasty. J Bone Joint Surg Am 98:1683–1690. https://doi.org/10.2106/jbjs.15.01365

    Article  PubMed  Google Scholar 

  32. Wyatt RW, Inacio MC, Liddle KD, Maletis GB (2013) Factors associated with meniscus repair in patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med 41:2766–2771. https://doi.org/10.1177/0363546513503287

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

No funding was obtained for this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Sahil Dadoo, Laura E. Keeling, Jonathan D. Hughes, Christopher Keenan, James J. Irrgang, Bryson P. Lesniak & Volker Musahl

  2. Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA

    Sean J. Meredith

  3. University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Mark Viecelli

  4. Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA

    James J. Irrgang

Authors
  1. Sahil Dadoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sean J. Meredith
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura E. Keeling
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jonathan D. Hughes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christopher Keenan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mark Viecelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. James J. Irrgang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bryson P. Lesniak
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Volker Musahl
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

S.D., S.J.M., and L.E.K. contributed to study design, data collection and analysis, and manuscript preparation. C.K. contributed to data collection and analysis. M.V. contributed to database preparation and data collection. J.D.H, J.J.I, B.P.L, and V.M. contributed to study design and manuscript preparation. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sahil Dadoo.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

S.D., S.J.M, L.E.K., J.D.H., C.K., M.V., and B.P.L have no disclosures or conflicts of interest. J.J.I. has the following disclosures: NIH Grant Support: W81XWH-15–1-0655. V.M. has the following disclosures. Education: Smith & Nephew, Arthrex, DePuy Synthes, Conmed. Consulting: Smith & Nephew, Newclip, Ostesys. Royalties: Springer. Shareholder: Ostesys. Board Member: ACL Study Group, AOSSM, ISAKOS, KSSTA (Deputy Editor-in-chief). Co-developer of iPad app (Serial No. 61/566,761). NIH Grant Support: U01AR076144, W81XWH-16-PRORP-ICTA.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dadoo, S., Meredith, S.J., Keeling, L.E. et al. Surgeon anterior cruciate ligament reconstruction volume and rates of concomitant meniscus repair. J EXP ORTOP 10, 61 (2023). https://doi.org/10.1186/s40634-023-00626-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s40634-023-00626-8

Keywords