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J Knee Surg 2022; 35(10): 1091-1096
DOI: 10.1055/s-0040-1722324
Original Article

Time from Injury Is the Key Predictor of Meniscal Injury in ACL-Deficient Knees

Seyed Mohammad Javad Mortazavi 
1   Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Science, Tehran, Iran
,
Alireza Moharrami 
1   Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Science, Tehran, Iran
,
S. S. Tamhri
1   Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Science, Tehran, Iran
,
Ali Okati
1   Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Science, Tehran, Iran
,
Ahmad Shamabadi 
1   Department of Orthopedic Surgery, Joint Reconstruction Research Center, Tehran University of Medical Science, Tehran, Iran
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Abstract

The meniscus is one of the most important structures of the knee that needs to be saved if possible. Previous studies showed that increasing time from an anterior cruciate ligament (ACL) injury (TFI) could lead to a meniscal tear, especially medial meniscus (MM). We developed the present study to see if the TFI alone is a predictor of meniscal injury in ACL-deficient knees. We included 111 patients who had a reconstructed ACL injury at our institution from March 2015 to March 2016 in this retrospective cohort study. All demographic data, including age, gender, and body mass index (BMI), were collected. We also recorded the mechanism of injury and the TFI. We extracted the meniscal condition at the time of surgery from the surgical report. All patients were followed up for a mean of 23 months, and the Lysholm score and pain visual analog scale (VAS) score were obtained. The mean TFI of patients with MM tear was 17.4 ± 16.8 months, which was significant than the patients with lateral meniscal (LM) tear (9.3 ± 8.3 months) and intact meniscus (7.4 ± 8.1 months) (p = 0.001). Patients with TFI less than 6 months had a significantly lower rate of MM tear, and increasing TFI more than 6 months could increase the rate of MM tear (p = 0.001). We could not find any association between age, BMI, and gender and meniscal injury. At the latest follow-up, Lysholm and VAS scores in patients with and without meniscal tear were the same. Our study confirms that increasing time from the ACL injury would increase the risk of MM damage. The cutoff point for this risk factor is 6 months from initial injury; therefore, to save the meniscus, it might be better to perform ACL reconstruction within 6 months in ACL-deficient knees.

Keywords

anterior cruciate ligament tear - meniscal tear - time from injury

Note

The investigation was performed at the Joint Reconstruction Research Center at Tehran University Medical Sciences, Tehran, Iran.




Publication History

Received: 09 April 2020

Accepted: 12 November 2020

Article published online:
22 February 2021

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  • References

  • 1 Razi M, Mortazavi SMJ. Save the meniscus, a good strategy to preserve the knee. Arch Bone Jt Surg 2020; 8 (01) 1-4
    PubMedGoogle Scholar
  • 2 Roos H, Adalberth T, Dahlberg L, Lohmander LS. Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: the influence of time and age. Osteoarthritis Cartilage 1995; 3 (04) 261-267
    CrossrefPubMedGoogle Scholar
  • 3 Tandogan RN, Taşer O, Kayaalp A. et al. Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc 2004; 12 (04) 262-270
    CrossrefPubMedGoogle Scholar
  • 4 Maffulli N, Osti L. ACL stability, function, and arthritis: what have we been missing?. Orthopedics 2013; 36 (02) 90-92
    CrossrefPubMedGoogle Scholar
  • 5 Feucht MJ, Bigdon S, Bode G. et al. Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns. J Orthop Surg Res 2015; 10: 34-34
    CrossrefPubMedGoogle Scholar
  • 6 Mansori AE, Lording T, Schneider A, Dumas R, Servien E, Lustig S. Incidence and patterns of meniscal tears accompanying the anterior cruciate ligament injury: possible local and generalized risk factors. Int Orthop 2018; 42 (09) 2113-2121
    CrossrefPubMedGoogle Scholar
  • 7 Forman SK, Jackson DW. Cyclops lesions. The Anterior Cruciate Ligament: Current and Future Concepts.. New York: Raven; 1993: 365-372
    Google Scholar
  • 8 Gillquist J, Messner K. Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis. Sports Med 1999; 27 (03) 143-156
    CrossrefPubMedGoogle Scholar
  • 9 McDaniel Jr WJ, Dameron Jr TB. The untreated anterior cruciate ligament rupture. Clin Orthop Relat Res 1983; (172) 158-163
    PubMedGoogle Scholar
  • 10 Chen G, Tang X, Li Q, Zheng G, Yang T, Li J. The evaluation of patient-specific factors associated with meniscal and chondral injuries accompanying ACL rupture in young adult patients. Knee Surg Sports Traumatol Arthrosc 2015; 23 (03) 792-798
    CrossrefPubMedGoogle Scholar
  • 11 Ford GM, Hegmann KT, White Jr GL, Holmes EB. Associations of body mass index with meniscal tears. Am J Prev Med 2005; 28 (04) 364-368
    CrossrefPubMedGoogle Scholar
  • 12 Michalitsis S, Vlychou M, Malizos KN, Thriskos P, Hantes ME. Meniscal and articular cartilage lesions in the anterior cruciate ligament-deficient knee: correlation between time from injury and knee scores. Knee Surg Sports Traumatol Arthrosc 2015; 23 (01) 232-239
    CrossrefPubMedGoogle Scholar
  • 13 Papageorgiou CD, Gil JE, Kanamori A, Fenwick JA, Woo SL, Fu FH. The biomechanical interdependence between the anterior cruciate ligament replacement graft and the medial meniscus. Am J Sports Med 2001; 29 (02) 226-231
    CrossrefPubMedGoogle Scholar
  • 14 Papastergiou SG, Koukoulias NE, Mikalef P, Ziogas E, Voulgaropoulos H. Meniscal tears in the ACL-deficient knee: correlation between meniscal tears and the timing of ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2007; 15 (12) 1438-1444
    CrossrefPubMedGoogle Scholar
  • 15 Yan F, Xie F, Gong X, Wang F, Yang L. Effect of anterior cruciate ligament rupture on secondary damage to menisci and articular cartilage. Knee 2016; 23 (01) 102-105
    CrossrefPubMedGoogle Scholar
  • 16 Makris EA, Hadidi P, Athanasiou KA. The knee meniscus: structure-function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials 2011; 32 (30) 7411-7431
    CrossrefPubMedGoogle Scholar
  • 17 Brambilla L, Pulici L, Carimati G. et al. Prevalence of associated lesions in anterior cruciate ligament reconstruction: correlation with surgical timing and with patient age, sex, and body mass index. Am J Sports Med 2015; 43 (12) 2966-2973
    CrossrefPubMedGoogle Scholar
  • 18 Anstey DE, Heyworth BE, Price MD, Gill TJ. Effect of timing of ACL reconstruction in surgery and development of meniscal and chondral lesions. Phys Sportsmed 2012; 40 (01) 36-40
    CrossrefPubMedGoogle Scholar
  • 19 Fok AW, Yau WP. Delay in ACL reconstruction is associated with more severe and painful meniscal and chondral injuries. Knee Surg Sports Traumatol Arthrosc 2013; 21 (04) 928-933
    CrossrefPubMedGoogle Scholar
  • 20 Slauterbeck JR, Kousa P, Clifton BC. et al. Geographic mapping of meniscus and cartilage lesions associated with anterior cruciate ligament injuries. J Bone Joint Surg Am 2009; 91 (09) 2094-2103
    CrossrefPubMedGoogle Scholar
  • 21 Sanders TL, Kremers HM, Bryan AJ. et al. Is anterior cruciate ligament reconstruction effective in preventing secondary meniscal tears and osteoarthritis?. Am J Sports Med 2016; 44 (07) 1699-1707
    CrossrefPubMedGoogle Scholar
  • 22 Taketomi S, Inui H, Yamagami R. et al. Surgical timing of anterior cruciate ligament reconstruction to prevent associated meniscal and cartilage lesions. J Orthop Sci 2018; 23 (03) 546-551
    CrossrefPubMedGoogle Scholar
  • 23 Chhadia AM, Inacio MC, Maletis GB, Csintalan RP, Davis BR, Funahashi TT. Are meniscus and cartilage injuries related to time to anterior cruciate ligament reconstruction?. Am J Sports Med 2011; 39 (09) 1894-1899
    CrossrefPubMedGoogle Scholar
  • 24 Kluczynski MA, Marzo JM, Bisson LJ. Factors associated with meniscal tears and chondral lesions in patients undergoing anterior cruciate ligament reconstruction: a prospective study. Am J Sports Med 2013; 41 (12) 2759-2765
    CrossrefPubMedGoogle Scholar
  • 25 Ulusoy GR, Kizilgoz V, Sivrioglu AK. Relationship between body mass index and articular injuries accompanying primary anterior cruciate ligament tear in male knees: a retrospective observational study. J Knee Surg 2020; 33 (11) 1157-1162
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Mehl J, Otto A, Baldino JB. et al. The ACL-deficient knee and the prevalence of meniscus and cartilage lesions: a systematic review and meta-analysis (CRD42017076897). Arch Orthop Trauma Surg 2019; 139 (06) 819-841
    CrossrefPubMedGoogle Scholar