Rate Of Medial Meniscal Tears Research Articles

Association Between Knee Alignment and Meniscal Tear in Pediatric Patients with Anterior Cruciate Ligament Injury.

The present study aimed to evaluate the association between elapsed time from anterior cruciate ligament (ACL) injury to surgical treatment and the incidence of meniscal tears in a cohort of patients ≤16 years old with varus-aligned and non-varus-aligned knees. The study cohort included 123 patients ≤16 years old who underwent primary ACL reconstruction between January 2016 and March 2020. Knee alignment was expressed as the hip-knee-ankle angle (HKAA), as measured preoperatively on an anteroposterior view of 3-dimensional computed tomography of the full length of the lower limb. Varus alignment was defined as an HKAA ≥181.0°, and non-varus alignment was defined as an HKAA <181.0°. Patients were divided into groups according to knee alignment and the elapsed time from injury to surgical treatment: early-treatment group (<60 days) and delayed-treatment group (≥60 days). A total of 64 varus-aligned and 59 non-varus-aligned knees were identified. Among patients with varus-aligned knees, those in the delayed-treatment group showed a significantly lower rate of lateral meniscal tears (6 of 30, 20%) compared with those in the early-treatment group (17 of 34, 50%; p = 0.015). Among patients with non-varus-aligned knees, there was no significant difference in meniscal tears of any type between the early and delayed-treatment groups. Among patients without medial meniscal injury identified on initial magnetic resonance imaging, those with varus-aligned knees in the delayed-treatment group showed a significantly higher rate of medial meniscal tears at the time of the surgical procedure (8 of 20, 40%) compared with those with non-varus-aligned knees (1 of 18, 6%; p = 0.015). Delayed ACL reconstruction in patients ≤16 years old with varus-aligned knees might be associated with an increased incidence of secondary medial meniscal tears. Accordingly, earlier ACL reconstruction in patients with varus-aligned knees should be considered. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Incidence of Associated Lesions of Multiligament Knee Injuries: A Systematic Review and Meta-analysis.

Background:The incidence of concomitant injuries, including meniscal and cartilage injuries, has not been adequately reported in previous studies on multiligament knee injury (MLKI) because their primary focal points have been the degree of ligament injury, treatment strategy, involvement of other soft tissues, and neurovascular injury.Purpose:To analyze the incidence of associated lesions in MLKIs, including medial and lateral meniscal injuries, cartilage lesions, and complications.Study Design:Systemic review; Level of evidence, 4.Methods:The PubMed, Embase, Cochrane Library, CINAHL, and Scopus databases were searched between inception and April 30, 2020. Studies were included if they reported the incidence rates of medial and/or lateral meniscal tears and cartilage injuries in cases of MLKIs. For the meta-analysis, data were extracted on clinical outcomes measured according to the number of medial and/or lateral meniscal tears, cartilage injuries, and complications.Results:A total of 45 studies were included in the MLKI analysis (3391 patients). The pooled rate of medial meniscal tears was 30.4% (95% CI, 24.1%-37.1%; P < .0001; I 2 = 85.8%). The pooled rate of lateral meniscal tears was 27.5% (95% CI, 20.3%-35.3%; P < .0001; I 2 = 89.6%). The pooled rate of cartilage injuries was 27.5% (95% CI, 22.1%-33.3%; P < .0001; I 2 = 86.8%). The pooled rates of peroneal nerve injuries, vascular injuries, and arthrofibrosis were 19.2% (95% CI, 14.2%-24.7%; P < .001; I 2 = 81.3%), 18.4% (95% CI, 13.2%-24.3%; P < .0001; I 2 = 81.0%), and 11.2% (95% CI, 8.1%-14.7%; P = .0018; I 2 = 54.0%), respectively.Conclusion:The pooled rates of meniscal tears and cartilage injuries concomitant with MLKIs were high, ranging from 27% to 30%, and the pooled rates of peroneal nerve injury, vascular injury, and arthrofibrosis were considerable, ranging from 11% to 19%. The influence of these associated lesions on clinical results should be evaluated in future clinical studies.

Anterior Cruciate Ligament Tears: The Impact of Increased Time From Injury to Surgery on Intra-articular Lesions.

Background:Previous research has shown that meniscal and articular cartilage lesions increase with time in the anterior cruciate ligament (ACL)–deficient knee.Purpose:To analyze the association between increased time from ACL injury to reconstruction and the presence of intra-articular lesions.Design:Cross-sectional study; Level of evidence, 3.Methods:A retrospective chart review was performed for patients who sustained an ACL injury and underwent reconstruction from January 1, 2009, to May 14, 2015. Factors analyzed included age, sex, and body mass index, as well as time from injury to surgery, the presence of meniscal tears, and the presence of cartilage lesions. The data were evaluated to quantify the association between time from ACL injury to reconstruction and presence of intra-articular lesions.Results:Overall, 405 patients were included in this study. Regarding time from injury, 27.3% patients were treated at <3 months, 23.6% at 3 to <6 months, 18% at 6 to <12 months, 13.6% at 12 to <24 months, 10.6% at 24 to <60 months, and 6.9% at ≥60 months. When compared with the group treated <3 months from injury, a significant increase in the rate of medial meniscal tears was seen in the groups treated at 6 to <12 months (odds ratio [OR], 2.2), 12 to <24 months (OR, 3.5), 24 to <60 months (OR, 7.0), and ≥60 months (OR, 6.3). A similar trend was seen with medial femoral condyle lesions in the groups treated at 6 to <12 months (OR, 2.5), 12 to <24 months (OR, 2.6), 24 to <60 months (OR, 2.6), and ≥60 months (OR, 6.9). The prevalence of lateral tibial plateau and lateral femoral condyle lesions also significantly increased with increased time between ACL injury and reconstruction, but this association was not seen until 24 to <60 months (ORs, 5.1 and 11.5, respectively).Conclusion:For patients undergoing ACL reconstruction, an interval >6 months between injury and surgery was associated with an increased prevalence of medial meniscal tears and medial compartment chondral lesions at the time of surgery. An interval >24 months between injury and surgery was associated with an increased prevalence of lateral compartment chondral lesions at the time of surgery.

Timing of Anterior Cruciate Ligament Reconstruction and Relationship With Meniscal Tears: A Systematic Review and Meta-analysis

Background: Anterior cruciate ligament (ACL) ruptures are common, but the ideal timing for ACL reconstruction after injury is unclear with regard to meniscal insult. Purpose: To determine whether there is a relationship between timing from ACL rupture to ACL reconstruction and development of meniscal tears within this period. Study Design: Systematic review and meta-analysis. Methods: A systematic literature search was undertaken independently by 2 reviewers using the Cochrane method for systematic reviews in 5 online databases. The reviewers performed independent data extraction and assessment of risk of bias and study quality. The search included any comparative study, including randomized controlled trials (RCTs), prospective and retrospective cohort studies, and case-control studies of an adult population, that assessed the relationship between timing of ACL reconstruction surgery and rates of meniscal tears. Results: After screening, 12 studies (No. of participants = 3042) out of 3390 records were included for analysis: 3 RCTs (n = 272), 2 prospective cohort studies (n = 307), and 7 retrospective cohort studies (n = 2463). In analysis of these studies, rates of reported meniscal tears were compared for ACL procedures performed at 3 and 6 months after injury. Meta-analysis of 5 studies (n = 2012) showed that ACL reconstruction performed >3 months after injury was associated with a higher rate of medial meniscal tears compared with ACL reconstruction performed within 3 months of injury (estimated OR, 2.235; 95% CI, 1.183-4.223; P = .013) but not with a higher rate of lateral meniscal tears. Similarly, meta-analysis of 4 studies (n = 990) showed that ACL reconstruction performed >6 months after injury was associated with a higher rate of medial meniscal tears compared with ACL reconstruction performed within 6 months of injury (estimated OR, 2.487; 95% CI, 1.241-4.984; P = .01) but not with a higher rate of lateral meniscal tears. Conclusion: Our results suggest that delay of ACL reconstruction surgery >3 months after injury is associated with a higher rate of medial meniscal tears within this prereconstruction time frame. Further high-quality prospective studies may help determine whether this is a causal effect. However, based on current evidence, in those patients for whom ACL reconstruction is indicated, ACL reconstruction within 3 months of injury may be recommended. Registration: CRD42016032846 (PROSPERO)

Incidence of Medial and Lateral Meniscal Tears After Delayed Anterior Cruciate Ligament Reconstruction in Pediatric Patients.

Background:The treatment of pediatric anterior cruciate ligament (ACL) injuries is controversial, and no clear management guidelines have been established.Purpose:To evaluate the association between elapsed time from ACL injury to surgery and the incidence of meniscal tears and chondral injuries in patients aged ≤16 years.Study Design:Cohort study; Level of evidence, 3.Methods:Between December 2012 and April 2019, a total of 207 consecutive knees in 207 patients aged ≤16 years underwent primary ACL reconstruction and were included in this study. Patients were divided into 1 of 2 groups (early group [≤150 days] and delayed group [>150 days]) based on the time between injury and surgery. Patient records, including arthroscopic findings identified by 2 experienced knee surgeons at the time of surgery, were reviewed for demographic information, incidence and types of medial and lateral meniscal tears, and chondral injuries and their locations in each group.Results:There were 180 knees in the early group and 27 knees in the delayed group. The delayed group showed a significantly higher rate of medial meniscal tears than the early group: 16 of 27 (59.2%) and 46 of 180 (25.6%), respectively (odds ratio [OR], 4.24 [95% CI, 1.83-9.33]; P = .0011). The delayed group had a significantly lower rate of lateral meniscal tears than the early group: 6 of 27 (22.2%) and 90 of 180 (50.0%), respectively (OR, 0.29 [95% CI, 0.11-0.70]; P = .007). The delayed group had significantly higher rates of chondral injuries in the medial femoral condyle and the medial tibial plateau than the early group: 8 of 27 (29.6%) and 25 of 180 (13.9%), respectively (OR, 2.61 [95% CI, 1.03-6.62]; P = .049), and 2 of 27 (7.4%) and 1 of 180 (0.6%), respectively (OR, 14.32 [95% CI, 1.58-208.10]; P = .045).Conclusion:Delayed ACL reconstruction was associated with an increased incidence of medial chondral injuries and medial meniscal tears but with a decreased incidence of lateral meniscal tears.

A 10-year Retrospective Review of Functional Outcomes of Adolescent Anterior Cruciate Ligament Reconstruction.

Rupture of the anterior cruciate ligament (ACL) is an increasingly prevalent sporting injury in adolescents. Surgical reconstruction of the ACL in adolescents has been controversial and there has been little reported on functional outcomes after surgery.The aim of this study was to undertake a retrospective notes review and questionnaire survey of a group of adolescents who had their ACL surgically reconstructed over the previous 10 years, assessing delay to surgery, levels of meniscal damage, reoperation rates, and functional outcomes. A retrospective chart review was performed on 100 adolescent patients who underwent arthroscopic ACL reconstruction using a transphyseal technique. These patients were also contacted and completed the Knee Osteoarthritis Outcome Score (KOOS). One hundred patients had their records reviewed. The average age at follow-up was 20.5 (SD, 2.4) years. There were 49 females and 51 males. Meniscal tears were present in 76% of patients at the time of surgery. The rate of medial meniscal tears increased with delay to surgical intervention beyond 3 months. Reoperation rate for these patients was 24%.Eighty patients completed the KOOS questionnaire. Patients were a mean of 4 (SD, 2.2) years postsurgery. The main findings indicate that in the 5 key KOOS domains patients scored a mean of 60 (SD, 13) for symptoms, 65 (SD, 10) for pain, 70 (SD, 6.4) for activities of daily living, 54 (SD, 17.6) for sport and recreation, and 47.2 (SD, 20.1) for quality of life. This study demonstrates that young people with ACL injuries have a very high associated incidence of meniscal pathology at the time of surgery. There is a high reoperation rate for meniscal surgery and graft failure. Four years post-ACL reconstruction many have not yet returned to a fully functional state.Further research to understand why functional outcomes are modest is required. Level IV-retrospective case series.

Rupture of the anterior cruciate ligament in children: early reconstruction with open physes or delayed reconstruction to skeletal maturity?

The purpose of this study was to compare two different strategies of management for ACL rupture in skeletally immature patient. In group 1, patients were treated in a children hospital by ACL reconstruction with open physis. In group 2, patients were treated in an adult hospital by delayed reconstruction at skeletal maturity assessed radiologically. Fifty-six consecutive patients were included in this retrospective study. Mean time from injury to surgery in group 1 and 2 was, respectively, 13.5 and 30 months. Patients from group 2 exhibited a higher rate of medial meniscal tears (41%) compare to group 1 (16%) and higher rate of meniscectomy. Both groups had the same rate of lateral meniscal tears. A temporary tibial valgus deformity was reported which was subsequently spontaneously resolved. No definitive growth disturbance was noticed. At 27 months mean follow-up, a best subjective IKDC score was found in group 1. Objective IKDC and radiological results were similar in both groups. Early ACL reconstruction is therefore a recommended option.