Effect of Delayed Primary Anterior Cruciate Ligament Reconstruction on Medial Compartment Cartilage and Meniscal Health

2019 ◽  
Vol 47 (8) ◽  
pp. 1816-1824 ◽  
Author(s):  
Joshua S. Everhart ◽  
J. Caid Kirven ◽  
Moneer M. Abouljoud ◽  
Alex C. DiBartola ◽  
Christopher C. Kaeding ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Medial Compartment ◽  
Meniscal Injury ◽  
Chondral Injury ◽  
Medial Meniscal Tear ◽  
Anterior Cruciate ◽  
Grade 3 ◽  
Outerbridge Grade

Background: The time required to develop a secondary cartilage or meniscal injury in the medial compartment after anterior cruciate ligament (ACL) injury is not well understood. Purpose: To determine the association between time delay until ACL reconstruction and the presence of medial compartment Outerbridge grade 3 or 4 chondral injury or medial meniscal tear requiring treatment. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 609 patients underwent primary ACL reconstruction at a single institution at a median 46 days between injury and surgery (61.4% male; mean age, 26.5 years [SD, 11.1]). Chondral status was graded according to Outerbridge criteria at the time of surgery. Multivariate regression analysis was used to assess the relationship between time delay until surgery and medial compartment chondral injury or meniscal injury requiring treatment. Adjustment was performed as needed for patient demographics, sporting activity, and prior knee injuries. Time until surgery had a nonlinear association with medial compartment health and was more effectively described in discrete intervals rather than as a continuous variable. The optimal time intervals to predict medial compartment health were determined by comparison of Bayes information criterion values between fully adjusted regression models. Results: After controlling for relevant confounders, delay of surgery >8 weeks had an increased likelihood of a medial meniscal tear requiring partial meniscectomy (adjusted odds ratio [aOR], 2.30; 95% CI, 1.04-5.12; P = .04) and a decreased likelihood of a meniscal tear requiring repair (aOR, 0.50; 95% CI, 0.32-0.76; P = .001). Delay of surgery >5 months had an increased likelihood of a medial Outerbridge grade ≥3 chondral defect (aOR, 3.11; 95% CI, 1.64-5.87; P = .001) or a grade 4 defect (aOR, 3.84; 95% CI, 1.75-8.45; P = .001). Conclusion: From the time of ACL injury, risk of an irreparable medial meniscal tear found at the time of ACL reconstruction is significantly increased by 8 weeks, and risk of high-grade medial chondral damage is increased by 5 months.

The Occurrence of Meniscal and Chondral Injury in Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Consecutive Case Series

2019 ◽  
Vol 33 (03) ◽  
pp. 223-227
Author(s):  
Floris R. van Tol ◽  
Willem A. Kernkamp ◽  
Robert J. P. van der Wal ◽  
Jan-Willem A. Swen ◽  
Samuel K. Van de Velde ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Partial Meniscectomy ◽  
Two Stage ◽  
Revision Acl Reconstruction ◽  
Chondral Injury ◽  
Anterior Cruciate ◽  
Two Stages

AbstractTwo-stage revision anterior cruciate ligament (ACL) reconstruction is an effective way to revise suboptimal tunnel-placement allowing for proper graft fixation. However, prolonged increased laxity of the knee may increase the risk of meniscal or chondral injury. It was hypothesized that no additional meniscal or chondral lesions occur in between the two stages of the two-stage revision ACL reconstruction. In this retrospective study, 42 patients undergoing a two-stage revision ACL reconstruction were included. Surgical notes for both stages were screened for meniscal and chondral status, interventions to any concurrent injury, surgery dates, along with basic patient characteristics. In 4 of the 42 patients, a new meniscal tear occurred in between the two stages, of which three required partial meniscectomy during the second stage of the ACL revision. One patient experienced a new small degenerative tear that did not require intervention. Two out of the four menisci that were repaired during the first stage had failed and required partial meniscectomy. No significant difference was found in the time between the two stages with respect to the occurrence of meniscal tears. No significant differences in chondral status were found. In conclusion, approximately 10% of patients developed a new meniscal tear and no difference in macroscopic chondral injury was observed between the first and second stages.

scholarly journals Risk Factors for Lateral Meniscus Posterior Root Tears in the Anterior Cruciate Ligament–Injured Knee: An Epidemiological Analysis of 3956 Patients From the SANTI Study Group

2019 ◽  
Vol 47 (3) ◽  
pp. 598-605 ◽  
Author(s):  
Cesar Praz ◽  
Thais Dutra Vieira ◽  
Adnan Saithna ◽  
Nikolaus Rosentiel ◽  
Vikram Kandhari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acl Reconstruction ◽  
Odds Ratio ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Significant Risk ◽  
Posterior Root ◽  
Medial Meniscal Tear ◽  
Anterior Cruciate

Background: Lateral meniscus posterior root tears (LMPRTs) result in loss of hoop forces and significant increases in tibiofemoral contact pressures. Preoperative imaging lacks reliability; therefore, holding an appropriate index of suspicion, based on the epidemiology of and risk factors for LMPRT, may reduce the rate of missed diagnoses. Purpose: The primary objectives of this study were to evaluate the incidence of and risk factors for lateral meniscus root lesions in a large series of patients undergoing anterior cruciate ligament (ACL) reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: All patients who underwent primary or revision ACL reconstruction by a single surgeon between January 2011 and April 2018 were considered for study eligibility. From this overall population, all patients who underwent repair of an LMPRT were identified. The epidemiology of LMPRT was defined by the incidence within the study population, stratified by key demographic parameters. Potentially important risk factors for the presence of LMPRT were evaluated in multivariate logistic regression analysis. Results: A total of 3956 patients undergoing ACL reconstruction were included in the study. An LMPRT was identified and repaired in 262 patients (6.6%). Multivariate analyses demonstrated that significant risk factors for LMPRT included a contact sports injury mechanism (7.8% incidence with contact sport mechanism vs 4.5% with noncontact mechanism; odds ratio, 1.69; 95% CI, 1.266-2.285; P < .001) and the presence of a medial meniscal tear (7.9% incidence with medial meniscal tear vs 5.8% without; odds ratio, 1.532; 95% CI, 1.185-1.979; P < .001). Although the incidence of LMPRT in male patients (7.3%) was higher than in females (4.8%), this was not significant in multivariate analysis ( P = .270). Patient age, revision ACL reconstruction, and a preoperative side-to-side laxity difference ≥6 mm were not significant risk factors for LMPRT. Conclusion: The incidence of LMPRT was 6.6% in a large series of patients undergoing ACL reconstruction. Participation in contact sports and the presence of a concomitant medial meniscal tear were demonstrated to be important independent risk factors. Their presence should raise the index of suspicion for this injury pattern.

scholarly journals EFFECT OF SKELETAL MATURITY ON INCIDENCE OF ASSOCIATED MENISCAL AND CHONDRAL INJURIES IN ANTERIOR CRUCIATE LIGAMENT INJURED KNEES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0010
Author(s):  
Brett Heldt ◽  
Elsayed Attia ◽  
Raymond Guo ◽  
Indranil Kushare ◽  
Theodore Shybut
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Medial Meniscus ◽  
Skeletal Maturity ◽  
Cruciate Ligament ◽  
Demographic Data ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Meniscus Tears ◽  
Anterior Cruciate

Background: Acute anterior cruciate ligament(ACL) rupture is associated with a significant incidence of concomitant meniscal and chondral injuries. However, to our knowledge, the incidence of these concomitant injuries in skeletally immature(SI) versus skeletally mature(SM) patients has not been directly compared. SI patients are a unique subset of ACL patients because surgical considerations are different, and subsequent re-tear rates are high. However, it is unclear if the rates and types of meniscal and chondral injuries differ. Purpose: The purpose of this study is to compare associated meniscal and chondral injury patterns between SI and SM patients under age 21, treated with ACL reconstruction for an acute ACL tear. We hypothesized that no significant differences would be seen. Methods: We performed a single-center retrospective review of primary ACL reconstructions performed from January 2012 to April 2020. Patients were stratified by skeletal maturity status based on a review of records and imaging. Demographic data was recorded, including age, sex, and BMI. Associated intra-articular meniscal injury, including laterality, location, configuration, and treatment were determined. Articular cartilage injury location, grade, and treatments were determined. Revision rates, non-ACL reoperation rates, and time to surgery were also compared between the two groups. Results: 785 SM and 208 SI patients met inclusion criteria. Mean BMI and mean age were significantly different between groups. Meniscal tear rates were significantly greater in SM versus SI patients in medial meniscus tears(P<.001), medial posterior horn tears(P=.001), medial longitudinal tears configuration(P=.007), lateral Radial configuration(P=.002), and lateral complex tears(P=.011). Medial repairs(P<.001) and lateral partial meniscectomies(P=.004) were more likely in the SM group. There was a significantly greater number of chondral injuries in the SM versus SI groups in the Lateral(p=.007) and medial compartments(P<.001). SM patients had a significantly increased number of outerbridge grade 1 and 2 in the Lateral(P<.001) and Medial Compartments(P=.013). ACL revisions(P=.019) and Non-ACL reoperations(P=.002) were significantly greater in the SI patients compared to SM. No other significant differences were noted. Conclusion: SM ACL injured patients have a significantly higher rate of medial meniscus tears and medial longitudinal configurations treated with repair, and a significantly higher rate of radial and/or complex lateral meniscus tears treated with partial meniscectomy compared to the SI group. We also found a significantly higher rate of both medial and lateral compartment chondral injuries, mainly grades 1 and 2, in SM compared to SI patients. Conversely, SI ACL reconstruction patients had higher revision and subsequent non-ACL surgery rates.

scholarly journals DELAY TO ACL RECONSTRUCTION IN PEDIATRIC AND ADOLESCENT PATIENTS IS ASSOCIATED WITH A LINEAR INCREASE IN THE RISK OF MEDIAL MENISCAL TEARS

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0004
Author(s):  
David A. Kolin ◽  
Brody Dawkins ◽  
Joshua Park ◽  
Peter D. Fabricant ◽  
Allison Gilmore ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Lateral Meniscus ◽  
Linear Increase ◽  
Meniscal Injury ◽  
Meniscal Tears ◽  
Increased Risk ◽  
Text Figure ◽  
Time From Injury

Background: Anterior cruciate ligament (ACL) tears are frequently associated with meniscal tears. Previous studies have shown that secondary meniscal tears—occurring after the initial ACL injury—are associated with greater delays from injury to ACL reconstruction (ACLR), but frequently use dichotomous categories of acute versus delayed ACLR. Purpose: As meniscal damage is likely accrued constantly over time, we investigated the variability of concurrent meniscal injuries as a function of time from injury to ACLR in a pediatric and adolescent population. Methods: We performed a retrospective review of all patients ≤18 years who underwent an ACLR between 2014 and 2018 at one of two tertiary academic hospitals. Outliers were excluded if time from injury to ACLR was greater than 78 weeks. Records were reviewed to assess patients’ dates of injury and surgery. The prevalence of concurrent medial and/or lateral meniscal injury was evaluated at the time of surgery for each patient. Adjusted relative risks (ARRs) of meniscal injury were calculated using Poisson regression models adjusted for age, sex, and body-mass index. Logistic regression was used to model the predicted probability of medial meniscal tears. Results: 546 patients met inclusion criteria. The mean age of participants was 15.3 years (S.D., 1.6), and 277 (50.7%) patients were male. Overall, 344 (63.0%) patients had a meniscal tear. 169 (49.1%) tears occurred at the medial meniscus, and 257 (74.7%) occurred at the lateral meniscus (Table 1). Compared to females, males had a greater risk of lateral meniscal injury (ARR, 1.46; 95% CI, 1.20-1.77) but not medial meniscal injury (ARR, 1.01; 95% CI, 0.77-1.31) (Figure 1). When considering all meniscal tears, time from injury to ACLR was not associated with increased risk of a tear (ARR, 1.01; 95% CI, 1.00-1.01). However, for medial meniscal tears, there was a significant association between time from injury to ACLR, in weeks, and meniscal tears (ARR, 1.02; 95% CI, 1.01-1.03, P = 0.003). A ten-week delay was associated with a 20% increased risk of medial meniscal injury (Figure 2). Conclusion: In pediatric and adolescent ACLR patients, the risk of any meniscal injury was not associated with delay from injury to surgery. However, the risk of medial meniscal injury increased by 2% each week from injury to surgery. [Table: see text][Figure: see text][Figure: see text]

scholarly journals Poor Associations Between Radiographic Tibiofemoral Osteoarthritis and Patient-Reported Outcomes at 16 Years After Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712095117
Author(s):  
Fredrik Identeg ◽  
Eric Hamrin Senorski ◽  
Eleonor Svantesson ◽  
Kristian Samuelsson ◽  
Ninni Sernert ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Ikdc Score ◽  
Anterior Cruciate ◽  
Grade 3

Background: Radiographic tibiofemoral (TF) osteoarthritis (OA) is common in patients after anterior cruciate ligament (ACL) reconstruction at long-term follow-up. The association between radiographic OA and patient-reported outcomes has not been thoroughly investigated. Purpose: To determine the association between radiographic TF OA and patient-reported outcome measure (PROM) scores at 16 years after ACL reconstruction. Study Design: Case-control study; Level of evidence, 3. Methods: This study was based on 2 randomized controlled studies comprising 193 patients who underwent unilateral ACL reconstruction. A long-term follow-up was carried out at 16.4 ± 1.7 years after surgery and included a radiographic examination of the knee and recording of PROM scores. Correlation analyses were performed between radiographic OA (Kellgren-Lawrence [K-L], Ahlbäck, and cumulative Fairbank grades) and the PROMs of the International Knee Documentation Committee (IKDC) subjective knee form, Lysholm score, and Tegner activity scale. A linear univariable regression model was used to assess how the IKDC score differed with each grade of radiographic OA. Results: Of 193 patients at baseline, 147 attended the long-term follow-up. At long-term follow-up, 44.2% of the patients had a K-L grade of ≥2 in the injured leg, compared with 6.8% in the uninjured leg. The mean IKDC score at follow-up was 71.2 ± 19.9. Higher grades of radiographic OA were significantly correlated with lower IKDC and Lysholm scores ( r = –0.36 to –0.22). Patients with a K-L grade of 3 to 4 had significantly lower IKDC scores compared with patients without radiographic OA (K-L grade 0-1). Adjusted beta values were –15.7 (95% CI, –27.5 to –4.0; P = .0093; R 2 = 0.09) for K-L grade 3 and –25.2 (95% CI, –41.7 to –8.6; P = .0033; R 2 = 0.09) for K-L grade 4. Conclusion: There was a poor but significant correlation between radiographic TF OA and more knee-related limitations, as measured by the IKDC form and the Lysholm score. Patients with high grades of radiographic TF OA (K-L grade 3-4) had a statistically significant decrease in IKDC scores compared with patients without radiographic TF OA at 16 years after ACL reconstruction. No associations were found between radiographic TF OA and the Tegner activity level.

scholarly journals Predictors of Radiographic Osteoarthritis 2-3 Years after ACL Reconstruction: Data from MOON Onsite Nested Cohort

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0034
Author(s):  
Morgan H. Jones ◽  
Sameer R. Oak ◽  
Jack T. Andrish ◽  
Robert H. Brophy ◽  
Charles L. Cox ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Meniscal Repair ◽  
Cartilage Lesion ◽  
Partial Meniscectomy ◽  
Medial Compartment ◽  
Acl Tear ◽  
Increased Risk ◽  
And Cartilage

Objectives: Multiple studies have shown patients are susceptible to post-traumatic osteoarthritis (PTOA) after anterior cruciate ligament (ACL) injury even with ACL reconstruction (ACLR). Prospective studies using multivariate analysis to identify risk factors for PTOA are lacking. This study aims to identify baseline predictors of radiographic PT OA after ACLR at an early time point and hypothesizes that meniscal injury and cartilage lesions will be associated with worse radiographic OA using the Osteoarthritis Research Society International (OARSI) atlas criteria. Methods: 421 patients who underwent ACLR returned onsite for standardized posteroanterior metatarsophalangeal radiographs a minimum of 2 years after surgery. At baseline, demographics, graft type, meniscal status/treatment, and cartilage status were collected. OARSI atlas criteria were used to grade all knee radiographs. Multivariable ordinal regression models identified baseline predictors of radiographic OARSI grades at follow-up. Results: The mean age was 19.8 years with 51.3% females. Higher age (odds ratio (OR) 1.06) and BMI (OR 1.05) were statistically significantly associated with higher OARSI grade in the medial compartment. Patients with a meniscal repair and a partial meniscectomy had statistically significantly higher OARSI grades in the medial compartment (meniscal repair OR 1.92 and meniscectomy OR 2.11) and in the lateral compartment (meniscal repair OR 1.96 and meniscectomy OR 2.97). Graft type, cartilage lesion, sex, and Marx activity scales had no significant association with OARSI grade. Conclusion: Older patients with a higher BMI who have an ACL tear with concurrent meniscal tear requiring partial meniscectomy or meniscal repair should be advised of their increased risk of developing radiographic OA. Alternatively, patients with an ACL tear with an articular cartilage lesion can be reassured that they are not at increased risk of developing radiographic knee OA at 2-3 years following ACLR.

Secondary Meniscal Tears in Patients With Anterior Cruciate Ligament Injury: Relationship Among Operative Management, Osteoarthritis, and Arthroplasty at 18-Year Mean Follow-up

2019 ◽  
Vol 47 (7) ◽  
pp. 1583-1590 ◽  
Author(s):  
Michella H. Hagmeijer ◽  
Mario Hevesi ◽  
Vishal S. Desai ◽  
Thomas L. Sanders ◽  
Christopher L. Camp ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Acl Injury ◽  
Nonoperative Treatment ◽  
Meniscal Tears ◽  
Acl Injuries ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injury is one of the most frequent orthopaedic injuries and reasons for time loss in sports and carries significant implications, including posttraumatic osteoarthritis (OA). Instability associated with ACL injury has been linked to the development of secondary meniscal tears (defined as tears that develop after the initial ACL injury). To date, no study has examined secondary meniscal tears after ACL injury and their effect on OA and arthroplasty risk. Purpose: To describe the rates and natural history of secondary meniscal tears after ACL injury and to determine the effect of meniscal tear treatment on the development of OA and conversion to total knee arthroplasty (TKA). Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database of >500,000 patients was reviewed to identify patients with primary ACL injuries between January 1, 1990, and December 31, 2005. Information was collected with regard to ACL injury treatment, rates/characteristics of the secondary meniscal tears, and outcomes, including development of OA and conversion to TKA. Kaplan-Meier and adjusted multivariate survival analyses were performed to test for the effect of meniscal treatment on survivorship free of OA and TKA. Results: Of 1398 primary ACL injuries, the overall rate of secondary meniscal tears was 16%. Significantly lower rates of secondary meniscal tears were noted among patients undergoing acute ACL reconstruction within 6 months (7%) as compared with patients with delayed ACL reconstruction (33%, P < .01) and nonoperative ACL management (19%, P < .01). Of the 235 secondary meniscal tears identified (196 patients), 11.5% underwent repair, 73% partial meniscectomy, and 16% were treated nonoperatively. Tears were most often medial in location (77%) and complex in morphology (56% of medial tears, 54% of lateral tears). At the time of final follow-up, no patient undergoing repair of a secondary meniscal tear (0%) underwent TKA, as opposed to 10.9% undergoing meniscectomy and 6.1% receiving nonoperative treatment ( P = .28). Conclusion: Secondary meniscal tears after ACL injury are most common among patients undergoing delayed surgical or nonoperative treatment of their primary ACL injuries. Secondary tears often present as complex tears of the medial meniscus and result in high rates of partial meniscectomy.

scholarly journals Meniscal Repair with Concurrent Anterior Cruciate Ligament Reconstruction: Is ACL Graft Choice Predictive of Meniscal Repair Success?

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0035
Author(s):  
Hytham S. Salem ◽  
Laura J. Huston ◽  
Alex Zajichek ◽  
Michelle Lora Wolcott ◽  
Eric C. McCarty ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Meniscal Repair ◽  
Acl Graft ◽  
Baseline Activity ◽  
Graft Choice ◽  
Significant Difference ◽  
Anterior Cruciate

Objectives: The success rate of meniscal repair is known to increase with concurrent anterior cruciate ligament (ACL) reconstruction. However, the influence of ACL graft choice has not been described. The current study examines the effect of ACL graft choice on the outcome of meniscal repair performed in conjunction with ACL reconstruction (ACLR). Methods: Patients who underwent meniscal repair with concurrent primary ACLR were identified from a longitudinal, prospective cohort. Patient demographics and subjective outcome measures including the International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), and Marx activity rating scale were collected preoperatively. Arthroscopic assessment of meniscal tear characteristics and associated repair technique were recorded intraoperatively. Patients with subsequent repair failure, defined as any subsequent surgical procedure addressing the meniscus repaired at index surgery, were identified and operative notes were obtained in order to accurately classify pathology and treatment. A logistic regression model was built to assess the association of patient specific factors, ACL graft, baseline Marx activity level and meniscal tear laterality with the occurrence of repair failure at 6-year follow-up. Results: A total of 646 patients underwent ACLR with concurrent meniscal repair. Bone-patellar tendon-bone (BTB) and soft tissue (ST) autograft were used in 55.7% and 33.9% of cases, respectively, while allografts were utilized in the remaining cases. Table 1 summarizes the univariate analysis of each baseline variable. A total of 101 patients (15.6%) required subsequent surgery on the meniscus repaired at index surgery, including 89 meniscectomies (87 partial, 2 subtotal), 11 revision meniscal repairs, and 1 meniscus allograft transplantation. No statistically significant difference in meniscal repair failure rate was observed based on patient age, sex, BMI or smoking status. The odds of meniscal repair failure within 6 years of surgery for patients with only a lateral meniscal repair are 68% less than those with only a medial meniscal repair (CI: 41%, 83%; p<0.001). There is a statistically significant relationship between baseline Marx activity and the risk of subsequent meniscal repair, though it is nonlinear—patients with low or high baseline activity are at the highest risk of meniscal repair failure (CI: 1.05,1.31; p=0.004, Figure 1). The estimated odds of meniscal repair failure for BTB allograft, ST allograft, and ST autograft were 2.78 (CI: 0.84,9.19; p=0.09), 2.29 (CI: 0.97,5.45; p=0.06), and 1.42 (CI:0.87,2.32; p=0.16) times that of BTB autograft, respectively, although none proved statistically significant. Meniscal repair failure is associated with significantly lower 6-year scores for all KOOS components and the IKDC (p<0.001). However, there was no significant difference in MARX activity at 6-years (p=0.27). Conclusion: In the setting of primary ACLR, the risk of meniscal repair failure is increased with medial versus lateral meniscal repair. Patients with low or high baseline activity levels are also at an increased risk. ACL graft choice seems to have an effect on meniscal repair failure that approaches but does not reach statistical significance. A larger sample size may be required to accept the null hypothesis. [Table: see text][Figure: see text]

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

2021 ◽  
Author(s):  
Seyed Mohammad Javad Mortazavi ◽  
Alireza Moharrami ◽  
S. S. Tamhri ◽  
Ali Okati ◽  
Ahmad Shamabadi
Keyword(s):  
Cruciate Ligament ◽  
Demographic Data ◽  
Meniscal Tear ◽  
Acl Injury ◽  
Meniscal Injury ◽  
Pain Visual Analog Scale ◽  
Initial Injury ◽  
Anterior Cruciate ◽  
And Gender ◽  
Acl Deficient

AbstractThe 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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