The Effects of Time Course after Anterior Cruciate Ligament Injury in Correlation with Meniscal and Cartilage Loss

Abstract

In this study, 130 consecutive patients with anterior cruciate ligament insufficiency who were undergoing ligament reconstruction underwent arthroscopic examination at the time of reconstruction, and any loss of meniscal or chondral integrity was documented in a systematic fashion. In these patients, a greater proportion of the medial meniscus was lost compared with the lateral meniscus (16% versus 5%). On average, 6 cm2 of the articular cartilage was damaged (5.2 cm2) or lost (0.8 cm2), with the area of damage and loss greatest on the medial femoral condyle. Patients whose injuries had occurred more than 2 years before the examination had more than sixfold greater cartilage loss and damage compared with those whose injuries had occurred within the past 2 months. Meniscal loss was associated with a threefold increase in cartilage damage or loss. The group of patients with meniscal loss whose initial anterior cruciate ligament injury occurred more than 2 years before examination exhibited 18 times the amount of cartilage loss or damage as did the group that had no meniscal loss and whose injury occurred less than 1 month before examination.

The Health and Structural Consequences of Acute Knee Injuries Involving Rupture of the Anterior Cruciate Ligament

“…As previously discussed, both meniscal injury and direct articular cartilage trauma are linked to long-term cartilage damage following a knee injury and are predictive of long term tibiofemoral and patellofemoral osteoarthritis 48 . Given that isolated rupture of the ACL is relatively rare, and the majority of ACL ruptures are accompanied by meniscal and chondral damage, the overall rate of osteoarthritis following an injury resulting in an ACL rupture is likely to be closer to the quoted 'combined injury' rate than that reported for 'isolated injuries' 19,20,34 .…”

“…Damage to the menisci is observed in approximately 65-75% of ACL-ruptured knees during arthroscopy 19,34 . Traumatic longitudinal tears in the posterior and middle one-third of the medial menisci account for the majority of lesions, although damage to the posterior-middle portion of the lateral meniscus is also relatively common 20 ( Figure 2).…”

“…Murrel et al found patients with meniscal injury had a three-fold increased in cartilage damage two years post-injury, and partial or complete menisectomies have long been linked to cartilage damage and earlier-onset osteoarthritic changes 34,40,41 . This may indicate that the role of the menisci in reducing contact stresses and friction within the joint is protective of articular cartilage, and therefore the development of osteoarthritis.…”

“…This may indicate that the role of the menisci in reducing contact stresses and friction within the joint is protective of articular cartilage, and therefore the development of osteoarthritis. It is as yet unclear, however, whether the loss of the meniscal function actually causes articular cartilage damage, or is merely a concurrent destructive occurrence 34 .…”

“…The extent to which cartilage must be damaged in the initial trauma before structural damage becomes irreversible is not yet known, but it is possible that the regular occurrence of instability-related trauma and altered biomechanical loading could overwhelm the limited restorative capacity of the joint and lead to longer-term osteoarthritic changes 32 . Concurrent injury to the menisci and the corresponding loss of its protective function would merely serve to exacerbate the damage to articular cartilage 34 .…”