Meniscal tear analysis in anterior cruciate ligament rupture: A retrospective comparison of early versus delayed intervention

Introduction: Combined anterior cruciate ligament (ACL) and meniscal tear patterns and their effect on knee stability have been widely researched, however, their evolution and repairability from time of injury have been scarcely addressed. When addressed with delay, meniscal lesions associated with ACL tears may increase in severity and irreparability. This study aims to investigate the incidence, rate and pattern of meniscus tears in the context of ACL deficient knees and to assess the meniscal condition in early versus late ACL reconstruction (ACLR). The hypothesis was that an increased time between trauma and ACLR was associated with different meniscal tear patterns.

Material and methods: Between 2012 and 2022, ACL reconstruction was performed in 1,840 cases. Out of the reviewed 1,317 ACLR's 726 exhibited concomitant meniscal lesions. The mean age was 32 years ±10. Meniscal tear status was evaluated during arthroscopy according to the ISAKOS classification. Patients were divided into 2 groups according to injury-to-surgery time: <2 months (116; 16%) and >2 months (610; 84%).

Results: Vertical meniscal lesion was the prevalent pattern regardless of the meniscus involved and the time from injury to ACLR, accounting for 50 to 76% of the patients. No significant difference was found comparing patterns rates between early and delayed treatment groups for both compartments. There was a significant difference in the distribution of circumferential areas of meniscal tears when comparing the medial with the lateral compartment. However, no significant difference in circumferential distribution of medial or lateral meniscus tears are present when performing surgery within or beyond 2 months.

Conclusion: There was no difference in meniscal tear patterns between early and delayed ACLR. The most frequent meniscal tear pattern was the vertical tear. No difference was found in circumferential distribution of meniscal tears between early and delayed ACLR. However, the circumferential distribution of meniscal tears was different comparing medial and lateral meniscus.

Level of evidence: III.