Second-Look Arthroscopic Healing After Meniscal Repair Concomitant with Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study

Background/Objectives: Meniscal healing after repair concomitant with anterior cruciate ligament (ACL) reconstruction may vary by lesion characteristics. We evaluated second-look arthroscopic healing rates and factors associated with partial or non-healing, particularly vascular zone. Methods: This retrospective cohort included 109 patients (131 repaired menisci) undergoing second-look arthroscopy at least 12 months after ACL reconstruction with meniscal repair (mean interval, 16.3 ± 6.3 months). Healing was classified as complete, partial, or non-healing. Associations were examined using multivariable logistic generalized estimating equations (GEE) accounting for within-patient clustering. Results: Complete, partial, and non-healing occurred in 73 (55.7%), 34 (26.0%), and 24 (18.3%) menisci, respectively. Complete healing occurred in 41/62 red-red (66.1%) and 32/69 red-white zone tears (46.4%). Higher body mass index (BMI) (per kg/m2: adjusted odds ratio [aOR], 1.11; 95% confidence interval [CI], 1.00–1.22; p = 0.04), red-white versus red-red zone location (aOR, 3.29; 95% CI, 1.31–8.23; p = 0.01), and more sutures (per suture: aOR, 1.41; 95% CI, 1.08–1.83; p = 0.01) were associated with partial or non-healing in the primary analysis. However, sensitivity analyses showed less consistent associations for BMI and vascular zone, whereas the association with suture number was more consistent. Conclusions: Complete structural healing was observed in selected red-white zone tears. The association between suture number and partial or non-healing was comparatively consistent across analyses, although suture number may reflect tear extent and repair complexity rather than a causal effect. Associations with BMI and vascular zone should be interpreted cautiously.