Single-stage ACL reconstruction and displaced bucket handle Meniscus repair is associated with lower Meniscus repair failure rates compared to two-stage surgery.

Purpose: To compare displaced bucket-handle meniscus repair (BHMR) failure rates, subjective and objective knee function after BHMR in the setting of ACLR performed as a single-or two-stage procedure, and assess factors associated with BHMR survival. Methods: This retrospective study included patients who underwent surgery between February 2015 and December 2021 at one institution. Patients with a displaced bucket-handle meniscus tear (BHMT) and ACL-injury undergoing BHMR and ACLR as a single- (concomitant BHMR and ACLR) or two-stage (BHMR and subsequent ACLR) procedure were identified. The primary outcome was the 2-year BHMR failure rate following ACLR, defined as reoperation with meniscus re-repair or resection. Additionally, 6-month range of motion (ROM), isokinetic knee (extension, flexion) strength, 1-and 2-year Knee injury and Osteoarthritis Outcome Score (KOOS), Patient-acceptable symptom state (PASS), treatment failure (TF) were compared between the groups. Kaplan-Meier analysis was performed to assess BHMR survival, factors associated with repair survival were analysed through Cox proportional hazard regression analysis. Results: The cohort included 159 displaced BHMRs, 120 (75.5%) underwent single-stage surgery. The overall BHMR failure rate was 27% (43/159). The single-stage surgery group had significantly lower failure rate (15% vs. 35.9%, Conclusion: Patients who underwent single-stage displaced BHMR and ACLR had significantly lower BHMR failure rate compared to those who underwent two-stage surgery. Therefore, single-stage displaced BHMR and ACLR should be advocated, although patient-specific factors and further prospective studies remain important considerations. Level of Evidence: Level III.