Delaying ACL reconstruction is associated with increased rates of medial meniscal tear

Abstract

Purpose The aim of this study was to evaluate the relationship between the time from injury to ACL reconstruction (ACLR) and the rate as well as repairability of meniscal tears. Secondary aims were to evaluate the relationship between meniscal injury and Tegner Activity Scale, age, BMI, and gender. Methods Between 2012 and 2022, 1,840 consecutive ACLRs were performed. A total of 1,317 ACLRs were included with a mean patient age of 31.2 years ± 10.5 . Meniscal tear was assessed during arthroscopy using the ISAKOS classiication. Time from injury to ACLR, Tegner Activity Scale, age, BMI and gender were analysed in uni-and then in multivariate analyses. Patients were divided into four groups according to the time from injury to surgery: < 3 months (427; 32%), 3-6 months (388; 29%), 6-12 months (248; 19%) and > 12 months (254; 19%). Results Delaying ACLR > 12 months signiicantly increased the rate of medial meniscal (MM) injury (OR 1.14; p < 0.001). No correlation was found between a 3-or 6-month time from injury to surgery and MM tear. Performing ACLR > 3, 6, or 12 months after injury did not signiicantly increase the rate of lateral meniscal (LM) injury. Increasing Tegner activity scale was signiicantly associated with a lower rate of MM injury (OR 0.90; p = 0.020). An age > 30 years (OR 1.07; p = 0.025) and male gender (OR 1.13; p < 0.0001) was also associated with an increased rate of MM injury. Age > 30 years decreased the rate of MM repair (OR 0.85; p < 0.001). Male gender increased the rate of LM tear (OR 1.10; p = 0.001). Conclusion Performing ACLR more than 12 months after injury was associated with increased rates of MM injury but not with lower rates of repairable lesions. An increased pre-injury Tegner activity score was associated with a decreased rate of MM tear. Age > 30 years was associated with an increased rate of MM tear with concomitant ACL injury and a decreased rate of repairability of MM tear. ACLR should be performed within 12 months from injury to prevent from the risk of MM injury. Level of Evidence Level III.

Predictive Refined Computational Modeling of ACL Tear Injury Patterns

“…Furthermore, it has been suggested that restoring anterior/posterior and rotational knee laxity could help prevent further instability and subsequent damage to the articular cartilage and meniscus. For example, delayed ACL reconstruction for 5 months doubled the risk of medial meniscal surgery after ACL injury, and if delayed for 1 year, the risk was six times higher [7,40]. Therefore, using our model to predict a specific tear type could enable tear growth tracking to prevent severe injuries to adjacent tissues.…”

Intercondylar notch width and osteophyte width impact meniscal healing and clinical outcomes following transtibial pullout repair of medial meniscus posterior root tears

“…MM serves as a secondary stabiliser and exerts a significant posterior wedge effect. Consequently, in cases of ACL deficiency, the stress on the MM intensifies [23,25,26]. Furthermore, excessive anterior tibial translation resulting from ACL degeneration can increase the strain on the posterior segment of the MM, contributing to the development of MMPRTs [27].…”

A new neural network model that detects graft ruptures and contralateral anterior cruciate ligament injuries

“…Other possible reasons for the higher risk of contralateral injuries include biomechanical changes or altered neuromuscular function after ACL reconstruction [7], and concomitant MM injury or MM repair may also affect these factors. Therefore, it is recommended that ACL reconstruction be performed early after ACL injury to reduce concomitant MM injury [5,12]. The condition of the ACL reconstructed knee may have influenced contralateral ACL injury.…”