The natural history of meniscal tears in anterior cruciate ligament insufficiency

Abstract

We reviewed the meniscal status of 176 consecutive patients undergoing anterior cruciate ligament reconstruction acutely (less than 6 weeks from injury), subchronically (6 weeks to 12 months from injury), and chronically (more than 12 months from injury). The commonest tear was the single longitudinal vertical split of the medial meniscus. There was an increasing incidence of meniscal tears as the injury became more chronic, with a significant (P < 0.001) increase in medial meniscal tears; the incidence of lateral meniscal tears remained relatively constant. Seventy-five (43%) of the patients had one or both menisci repaired. Acutely, repair was performed more frequently on the medial meniscus than the lateral (80% versus 24%, respectively). All repaired menisci had single longitudinal tears unstable to probing. The incidence of repair dropped to 46% in the medial meniscus and 14% in the lateral meniscus in the chronic stage. Nineteen (25%) of these 75 patients (26 menisci) underwent a check arthroscopy at a minimum of 6 months from repair. All 21 medial menisci and all 5 lateral meniscal tears had healed; however, 1 lateral meniscus had torn along the line of the sutures. At an average followup of 40 months, 92% of the repaired menisci were still in situ and 8% that had required resection were related to the recurrence of anterior cruciate ligament instability. This study highlights the increasing incidence of meniscal injury in chronic anterior cruciate ligament insufficiency with the meniscal tears becoming more complex and therefore less amenable to suture.(ABSTRACT TRUNCATED AT 250 WORDS)

Meniscal Injury After Adolescent Anterior Cruciate Ligament Injury: How Long Are Patients at Risk?

“…With each episode of giving way, meniscal tears can become more complex and less amenable to repair [8]. Studies in adult patients [7,8,24,39] and in pediatric patients [12,28,32] have shown an increased incidence of medial meniscal tears with delayed ACL reconstruction. Although the treatment of ACL tears in skeletally immature patients remains controversial [33], the risk of physeal injury and resulting growth disturbance from ACL repair to a patient with open physes is now thought to be small [15,22], and many centers (including our institution) opt for prompt reconstruction before skeletal maturity [9,16,20,25,31,34,40].…”

Failure of meniscal repair association with late anterior cruciate ligament reconstruction

“…In the majority of these studies, it seems that the outcome of a repair is better with concomitant reconstruction than in knees that remain unstable or even better than knees without ACL injury. [10][11][12][13][14][15] It must be assumed that in the subgroup of patients with concomitant ACL reconstruction, the main reason for the procedure is instability, and that conclusively not only symptomatic but also clinically silent lesions of the meniscus are identified and repaired. However, in patients with stable knees, the cause for the meniscus repair usually is meniscus symptoms, such as locking or effusion.…”

Patterns of Meniscal Damage Associated with Acute ACL Rupture

“…The loss of ACL function increases tibial translation, allowing the meniscus to "engage" the femoral condyle and act as a wedge against the tibia [22,23], while others have suggested that mechanical trauma causes the MMTs in this setting [12,18,20]. Several studies have explored the relationship between ACL injury and meniscal tear [24][25][26][27][28][29][30]. Some showed preponderance of the LMTs in the acute setting and in osteoarthritis [24,25], others suggested the MMTs especially in acute reconstructions [26][27][28][29].…”

“…Several studies have explored the relationship between ACL injury and meniscal tear [24][25][26][27][28][29][30]. Some showed preponderance of the LMTs in the acute setting and in osteoarthritis [24,25], others suggested the MMTs especially in acute reconstructions [26][27][28][29].…”