Combined Injury to the ACL and Lateral Meniscus Alters the Geometry of Articular Cartilage and Meniscus Soon After Initial Trauma

Abstract

Combined injury to the anterior cruciate ligament (ACL) and meniscus is associated with earlier onset and increased rates of post‐traumatic osteoarthritis compared with isolated ACL injury. However, little is known about the initial changes in joint structure associated with these different types of trauma. We hypothesized that trauma to the ACL and lateral meniscus has an immediate effect on morphometry of the articular cartilage and meniscus about the entire tibial plateau that is more pronounced than an ACL tear without meniscus injury. Subjects underwent magnetic resonance imaging scanning soon after injury and prior to surgery. Those that suffered injury to the ACL and lateral meniscus underwent changes in the lateral compartment (increases in the posterior–inferior directed slopes of the articular cartilage surface, and the wedge angle of the posterior horn of the meniscus) and medial compartment (the cartilage‐to‐bone height decreased in the region located under the posterior horn of the meniscus, and the thickness of cartilage increased and decreased in the mid and posterior regions of the plateau, respectively). Subjects that suffered an isolated ACL tear did not undergo the same magnitude of change to these articular structures. A majority of the changes in morphometry occurred in the lateral compartment of the knee; however, change in the medial compartment of the knee with a normal appearing meniscus also occurred. Statement of clinical significance: Knee injuries that involve combined trauma to the ACL and meniscus directly affect both compartments of the knee, even if the meniscus and articular cartilage appears normal upon arthroscopic examination. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:759‐767, 2020

Articular cartilage thickness changes differ between males and females 4 years following anterior cruciate ligament reconstruction

“…This is an important concern, as we observed a much larger area of ACLR subjects cartilage demonstrated thickening. Our prior investigation of subjects suffering a first‐time noncontact ACL rupture, demonstrated that the thickness of medial tibial articular cartilage changes within days following the index ACL trauma 3,24 . Indeed, soon after the index injury, and before surgery, the thickness of the tibial articular cartilage in the areas of the medial compartment of the tibia of the ACL injured females underwent thickening and thinning relative to the contralateral normal knee 3 .…”

“…Our prior investigation of subjects suffering a first-time noncontact ACL rupture, demonstrated that the thickness of medial tibial articular cartilage changes within days following the index ACL trauma. 3,24 Indeed, soon after the index injury, and before surgery, the thickness of the tibial articular cartilage in the areas of the medial compartment of the tibia of the ACL injured females underwent thickening and thinning relative to the contralateral normal knee. 3 In the current study examining ACLR subjects, we found the location of the areas that underwent thickening and thinning of cartilage were similar to those identified soon after injury and before surgery.…”

Does Accelerated Rehabilitation Provide Better Outcomes Than Restricted Rehabilitation in Postarthroscopic Repair of Meniscal Injury?

“…Patients in the meniscus with ACL injury group underwent ACLR surgery and meniscus suturing; only 3 reported the suture techniques, 34,35,40 2 with inside-out technique, 35,41 and 1 with outside-in technique. 34 Four used semitendinosus and gracilis hamstring tendons for ACLR, 18,28,34,35 2 used bone-patellar tendon-bone, 37,42 and 2 used hamstring for reconstruction. 26,40 There were 4 studies who reported the usage of double bundles in ACLR.…”

Significance of the broad non-bony attachments of the anterior cruciate ligament on the tibial side

“…Knowledge of the anterior cruciate ligament (ACL) anatomy is important for understanding its function and the possible pathologies that may involve this structure. ACL injuries can occur simultaneously with damage to the lateral meniscus (LM) and articular cartilage 1 , 2 . Furthermore, in a cohort study of risk factors and predictors of subsequent ACL injury after ACL reconstruction, so-called the MOON study, risk factors for poor outcomes at 10 years after reconstruction included LM procedures and articular cartilage lesions 3 .…”