Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns

Abstract

BackgroundThe pattern of lateral meniscus tears observed in anterior cruciate ligament (ACL)-injured subjects varies greatly and determines subsequent management. Certain tear patterns with major biomechanical consequences should be repaired in a timely manner. Knowledge about risk factors for such tears may help to identify patients in the early posttraumatic phase and subsequently may improve clinical results.MethodsA database of 268 patients undergoing primary ACL reconstruction was used to identify all patients with isolated ACL tears and patients with an associated tear of the lateral meniscus. Patients who underwent surgery >6 months after the injury were excluded. Based on the arthroscopic appearance of the lateral meniscus, patients were assorted to one of three groups: ‘no tear,’ ‘minor tear,’ and ‘major tear.’ Tear patterns defined as major included root tears, complete radial tears, and unstable longitudinal tears including bucket-handle tears. Univariate analysis was performed by comparing the three groups with regard to gender, age, height, weight, BMI, type of injury (high-impact sport, low-impact sport, and not sports related), and mechanism of injury (non-contact vs. contact). Multivariate logistic regression was carried out to identify independent risk factors for minor and major meniscal tears and to calculate odds ratios (OR).ResultsTwo hundred fifteen patients met the inclusion and exclusion criteria. Of those, 56% had isolated ACL tears, 27% had associated minor tears, and 17% had associated major tears of the lateral meniscus. Univariate analysis revealed significant differences between the three groups for gender (p = 0.002), age groups (p = 0.026), and mechanism of injury (p < 0.001). A contact injury mechanism was a risk factor for minor tears (OR: 4.28) and major tears (OR: 18.49). Additional risk factors for major tears were male gender (OR: 7.38) and age <30 years (OR: 5.85).ConclusionMale patients, patients <30 years, and particularly patients who sustained a contact injury have a high risk for an associated major lateral meniscus tear. Special attention is therefore necessary in those patients and early referral to magnetic resonance imaging and/or arthroscopy is recommended to allow meniscus repair in a timely manner.

Anterior Cruciate Ligament Insufficiency: Delay in Surgery and Its Association with Spectrum of Intraarticular Knee Lesions

“…Lateral tibial condylar lesions were associated with RR=3.264(95% CI of 1.253 -8.503).. Chondral lesions of patella(14.2%), Trochlea (4.7%)& Lateral femoral condyle( 5.7%) though present, didn't have significant association with delay in surgery. Our observations in 106 patients have limitations in throwing light to association of chondral changes in patella, trochlea and lateral femoral condyle, as compared to some investigators 4,[25][26][27][28] , as the numbers in subtypes were minimal for statistical association. Delay in surgery was also found to have significant association with the presence of intraarticular knee lesions and their number (<3lesions />3 lesions) RR 1.177(CI 1,027-1.349),P-.02 .…”

Short cracks in knee meniscus tissue cause strain concentrations, but do not reduce ultimate stress, in single-cycle uniaxial tension

“…Loading rate is another potentially important factor. Meniscus tears often occur in the context of sports, implying involvement of high-rate loading (Drosos and Pozo 2004;Feucht et al 2015), and ex vivo impact testing has produced meniscus tears (Isaac et al 2010;Isaac et al 2008). It is possible that a high-rate loading cycle (as would be expected from an impact) can produce a long (5-25 mm) tear of clinical concern immediately, without slow growth from a low-risk short tear.…”

“…Their direct symptoms include pain, mechanical deficiency, and increased risk of osteoarthritis (Englund et al 2012;Øiestad et al 2009;Cohen et al 2007;Englund et al 2008). Meniscus tears can also cause serious secondary harm, as the most straightforward treatment for a tear-partial or total meniscectomy-further increases the risk of osteoarthritis Shelbourne and Gray 2000;Feucht et al 2015;Anetzberger et al 2014;Petty and Lubowitz 2011). Furthermore, repair of a torn meniscus, especially when the tear is in the inner avascular region, is not always feasible (Arnoczky and Warren 1983;Englund et al 2012).…”

“…Their direct symptoms include pain, mechanical deficiency, and increased risk of osteoarthritis (Englund et al 2012;Øiestad et al 2009;Cohen et al 2007;Englund et al 2008). Meniscus tears can also cause serious secondary harm, as the most straightforward treatment for a tear-partial or total meniscectomy-further increases the risk of osteoarthritis Shelbourne and Gray 2000;Feucht et al 2015;Anetzberger et al 2014;Petty and Lubowitz 2011) and repair of a torn meniscus, especially when the tear is in the inner avascular region, is not always feasible (Arnoczky and Warren 1983;Englund et al 2012). Meniscus tears may occur suddenly, suggestive of immediate failure from a single overload event (Fink et al 2018;Greis et al 2002;Wagemakers et al 2008;Cox et al 2009;Lento and Akuthota 2000;Poulsen and Johnson 2011;Paul et al 2003), but are also known to grow over time in vivo (Kumm et al 2015;Khan et al 2016).…”

Transosseous Repair of Root Tears of the Lateral Meniscus: Operative Technique and Short-Term Clinical Follow-Up of 28 Patients

“…Unlike posterior root tears of the medial meniscus which generally occur as a consequence of meniscal tissue degeneration and increased compartmental load, posterior lateral meniscus root tears (PLMRTs) usually occur following traumatic rotational distortion of the knee and are commonly associated with an anterior cruciate ligament (ACL) tear [1][2][3][4][5].…”