Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport

Abstract

The purposes of this multi-center study were: (a) to document the location and type of meniscal and chondral lesions that accompany anterior cruciate ligament (ACL) tears, and (b) to test for possible relationships between these lesions and patient age, time from initial injury (TFI), and sports level (i.e., recreation, amateur, professional, and national). The cases of 764 patients with ACL tears who underwent arthroscopy for the first time were retrospectively analyzed. The group included 684 males and 80 females of mean age 27 years (range 14-59 years). The mean TFI was 19.8 months (range 0.2-360 months). Eighty-seven percent of the group engaged in regular sporting activity. Thirty-seven percent had medial meniscal tears, 16% had lateral meniscal tears, and 20% had tears of both menisci. The most common tear types were longitudinal tears in the posterior and middle horns of both menisci. Tears of the lateral meniscus were more centrally located than those of the medial meniscus. Incomplete tears and radial tears were significantly more common in the lateral meniscus. Nineteen percent of the knees had one or more chondral lesions. Sixty percent of the chondral lesions were located in the medial tibio-femoral compartment. Patient age was statistically associated with presence of a medial meniscal tear, presence of a grade 3 or 4 chondral lesion, and presence of a complex tear of the medial meniscus. Sports level was not statistically related to any of the parameters studied. The odds of having a medial meniscal tear at 2 to 5 years TFI were 2.2 times higher than the odds in the first year post-injury, and the odds at >5 years were 5.9 times higher than at 0 to 12 months TFI. The frequency of lateral meniscal tear remained fairly constant at 2 years TFI. The odds of having a grade 3 or 4 chondral lesion were 2.7 times greater at 2 to 5 years TFI than they were at 1 year post-injury, and these odds increased to 4.7 when patients at >5 years TFI were compared to those in the 2 to 5 years category. Multivariate analysis demonstrated that TFI and age were equally important predictors of lateral meniscal tears and of grade 3 or 4 chondral lesions; however, TFI was the better predictor of medial meniscal tear.

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 .…”

“…Nearly half of knee injuries that result in an ACL rupture also cause direct articular cartilage damage, particularly on the medial (41-43%) and lateral (20%) femoral condyles 20,42 (Figure 3). Direct cartilage damage is associated with short-term matrix disruption, chondrocyte necrosis and proteoglycan loss 32 .…”

“…damage to the synovial joint [18][19][20][21] . These associated injuries are therefore worth discussing due to their potential role in the development of osteoarthritic changes.…”

Biomechanical Adaptations After Fatiguing Exercise in Healthy and ACL Reconstructed Individuals

“…34,94 Tears in the medial meniscus are more common than the lateral meniscus. 186 Injuries in the medial meniscus are also more common after initial ACL injury. 160,186 ACL injury with concomitant meniscal damage has been associated with worse subjective outcomes as well as increased prevalence of osteoarthritis.…”

“…186 Injuries in the medial meniscus are also more common after initial ACL injury. 160,186 ACL injury with concomitant meniscal damage has been associated with worse subjective outcomes as well as increased prevalence of osteoarthritis. 17,40,102 ACL injuries with concurrent meniscal damage requiring surgical intervention significantly shortens professional sports careers comparing to an ACL injury alone.…”