Purpose: To investigate the influence of surgical volume, and various patient-, injury-, and surgery-related factors, on meniscal treatment strategies in primary anterior cruciate ligament reconstruction (ACLR).

Methods: This retrospective cohort study analyzed patients with concomitant meniscal injuries undergoing primary ACLR, from 2008 to 2022, using data from the Swedish National Knee Ligament Registry. Surgeons and clinics were stratified by total caseload (cutoff: 50 ACLRs/surgeon, 500 ACLRs/clinic) and annual volume (cutoff: 29 ACLRs/year/surgeon, 56 ACLRs/year/clinic). To assess factors influencing medial meniscus or lateral meniscus repair, adjusted multivariable logistic regression was conducted, with results presented as odds ratios (OR) and 95% confidence intervals (CI).

Results: In total, 20,699 patients undergoing primary ACLR with concomitant meniscal injuries were included. Lower percentages of meniscus repair were seen among surgeons with low caseload and annual volume (LCLV) (13.3%-20.8%) compared with high caseload and annual volume (HCHV) surgeons (19.0%-29.8%), and at LCLV clinics (11.1%-18.3%) compared to HCHV clinics (21.5%-33.8%), all P < .001. Significantly decreased odds of medial meniscus repair were seen for patients operated on by LCLV surgeons (OR 0.82, 95% CI 0.70-0.96; P = .015) or at LCLV clinics (OR 0.56, 95% CI 0.50-0.64; P < .001. Similar results were seen for lateral meniscus repair with LCLV surgeons (OR 0.83, 95% CI 0.69-1.01; P = .067) and LCLV clinics (OR 0.62, 95% CI 0.53-0.72; P < .001). Additionally, younger age, female sex, shorter time from injury to surgery, and ACLRs performed more recently were associated with increased odds of repair.

Conclusions: Lower surgical volume significantly decreased the rates and odds of performing meniscal repair during primary ACLR. In contrast, ACLRs performed during more recent years, younger age, female sex, shorter time from injury to surgery, absence of chondral injuries, and injuries sustained during nonpivoting activities, positively influenced meniscal preservation.

Level of evidence: Level III, retrospective cohort study.