Incidence and patterns of meniscal tears accompanying the anterior cruciate ligament injury: possible local and generalized risk factors

Mansori, Ashraf El; Lording, Timothy; Schneider, Antoine; Dumas, Raphaël; Servien, Elvire; Lustig, Sébastien

doi:10.1007/s00264-018-3992-x

Cited by 65 publications

(69 citation statements)

References 39 publications

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“…statistically significant p values are bold with fields marked in gray have a higher rate of degenerative tears which is consistent with some previous studies [33]. However, other studies have reported a male predilection for meniscal tears due to traumatic lesions [34] and non-horizontal tears [35]. Our study results confirmed that the posterior horn is the most affected region for meniscal degeneration [13,18,19,36] and anterior horn is less often affected [19].…”

Section: Discussionsupporting

confidence: 92%

Natural history of new horizontal meniscal tears in individuals at risk for and with mild to moderate osteoarthritis: data from osteoarthritis initiative

et al. 2020

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Objectives To study the natural history of new horizontal meniscal tears and their association with progression of cartilage degeneration in individuals at risk for or with mild to moderate knee osteoarthritis over 4 years. Methods Individuals who developed a new meniscal tear in the right knee over 2 years were selected from the Osteoarthritis Initiative 3T MRI studies. Knee structural changes were analyzed at the time of tear appearance (baseline), and after 4 years using a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). Meniscal tears were classified as either horizontal tears or non-horizontal tears. Individuals without a meniscal tear were 1:3 frequency matched according to BMI, gender, race, and age and served as the control group. Linear regression analysis was used to compare cross-sectional and longitudinal changes in cartilage WORMS scores. Results Forty-one subjects developed horizontal tears, including one indiviudal who developed a tear in both menisci, and 34 developed non-horizonal tears. We found that (29/41 (70.7%)) of horizontal and (20/34 (58.8%)) of non-horizonatal tears were stable during follow-up (p = 0.281). Although knees with an incident tear had higher than controls WORMS MAX total knee scores at baseline (coef. = 0.47, p = 0.044, 95% CI = 0.01 to 0.93), there were no significant differences between the horizontal subgroup and knees without tears in overall cartilage scores at baseline and in progression over 4 years of follow-up. Conclusions New horizontal meniscal tears tended to be stable over 4 years and presented no significant differences in progression of cartilage degeneration when compared with knees without tears. Key Points • Most of horizonal meniscal tears were stable over 4 years. • There were no statistically significant differences in overall progression of cartilage degenerative changes between knees with horizonal meniscal tears and control knees without tears • Horizontal tears most often occurred at the posterior horn of the medial meniscus and at the body of the lateral meniscus.

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Section: Discussionsupporting

confidence: 92%

Natural history of new horizontal meniscal tears in individuals at risk for and with mild to moderate osteoarthritis: data from osteoarthritis initiative

et al. 2020

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“…Accordingly, time to surgery correlates with the incidence of concomitant meniscus injuries [25,29]. In particular, the incidence of medial meniscus (MM) tears seems to significantly 1 3 increase with delayed surgery [26,50]. Conversely, patients with medial or lateral meniscus instabilities have a significantly increased risk of ACL failure after reconstruction [32].…”

Section: Introductionmentioning

confidence: 99%

Ramp lesions are frequently missed in ACL-deficient knees and should be repaired in case of instability

Bumberger

Koller

Hofbauer

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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The aim of the current study was (1) to provide an overview of common definitions and classification systems of ramp lesions (RL) and (2) to systematically review the available literature with regard to the diagnosis and treatment of RLs in anterior cruciate ligament (ACL)-deficient knees. Methods Following the PRISMA guidelines, MEDLINE and Scopus were searched for articles (1) reporting on acute or chronic ACL injuries, (2) with concomitant medial meniscus injury, (3) located at the posterior meniscocapsular attachment site (and red-red zone). Ex vivo studies, reviews and technical notes were excluded. Results Twenty-seven studies were included based on the criteria mentioned above. RLs are common in ACL-deficient knees with a prevalence ranging from 9 to 24%. RLs should especially be suspected in younger patients, patients with an increased meniscal slope and in patients with prolonged time from injury to surgery. The sensitivity of MRI for the detection of RLs ranges from 48 to 86% at a specificity of 79-99%. For arthroscopy, RLs are easily missed through standard anterior portals (sensitivity 0-38%). RL repair leads to a significant improvement of subjective knee scores, regardless of the specific fixation technique. For stable RLs, the literature suggests equivalent postoperative stability for trephination and abrasion compared to surgical RL repair. Conclusion Ramp lesions are frequently missed in ACL-deficient knees on standard arthroscopy with anterior portals only. If a RL is suspected, exploration via an additional posteromedial portal is indicated. In case of instability, RL repair should be performed. Level of evidence IV.

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“…5 However, it was shown that even in patients with isolated ACL tears, meniscal injuries could occur due to knee instability and pivot. 6 This type of secondary meniscal damage in patients with long-standing ACL tear would contribute to knee later arthritic changes. 2,[7][8][9] Previous studies showed that patient's age, time from an ACL injury (TFI), sex, and obesity are predictors of meniscal tear in patients who underwent ACL reconstruction.…”

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confidence: 99%

Time from Injury Is the Key Predictor of Meniscal Injury in ACL-Deficient Knees

et al. 2021

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The meniscus is one of the most important structures of the knee that needs to be saved if possible. Previous studies showed that increasing time from an anterior cruciate ligament (ACL) injury (TFI) could lead to a meniscal tear, especially medial meniscus (MM). We developed the present study to see if the TFI alone is a predictor of meniscal injury in ACL-deficient knees. We included 111 patients who had a reconstructed ACL injury at our institution from March 2015 to March 2016 in this retrospective cohort study. All demographic data, including age, gender, and body mass index (BMI), were collected. We also recorded the mechanism of injury and the TFI. We extracted the meniscal condition at the time of surgery from the surgical report. All patients were followed up for a mean of 23 months, and the Lysholm score and pain visual analog scale (VAS) score were obtained. The mean TFI of patients with MM tear was 17.4 ± 16.8 months, which was significant than the patients with lateral meniscal (LM) tear (9.3 ± 8.3 months) and intact meniscus (7.4 ± 8.1 months) (p = 0.001). Patients with TFI less than 6 months had a significantly lower rate of MM tear, and increasing TFI more than 6 months could increase the rate of MM tear (p = 0.001). We could not find any association between age, BMI, and gender and meniscal injury. At the latest follow-up, Lysholm and VAS scores in patients with and without meniscal tear were the same. Our study confirms that increasing time from the ACL injury would increase the risk of MM damage. The cutoff point for this risk factor is 6 months from initial injury; therefore, to save the meniscus, it might be better to perform ACL reconstruction within 6 months in ACL-deficient knees.

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Incidence and patterns of meniscal tears accompanying the anterior cruciate ligament injury: possible local and generalized risk factors

Abstract: Level III.

Cited by 65 publications

References 39 publications

Natural history of new horizontal meniscal tears in individuals at risk for and with mild to moderate osteoarthritis: data from osteoarthritis initiative

Natural history of new horizontal meniscal tears in individuals at risk for and with mild to moderate osteoarthritis: data from osteoarthritis initiative

Ramp lesions are frequently missed in ACL-deficient knees and should be repaired in case of instability

Time from Injury Is the Key Predictor of Meniscal Injury in ACL-Deficient Knees

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