DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20202568

Effects of neglected anterior cruciate ligament tears on medial and lateral meniscus

Jeevan M. P., John T. John

Abstract


Background: The effects of neglected anterior cruciate ligament (ACL) tears and its impact on the medial and lateral meniscus was evaluated in this study over a one-year time period patients were grouped on the basis of their injury to treatment time. The study emphasized the importance of early treatment of ACL injury to prevent damage to the meniscal tissue and secondary osteoarthritis.

Methods: Retrospective cohort study undertaken in the Department of Orthopaedics at Lourdes Hospital, Ernakulam, Kerala. Over a time period of one year starting from 2010 February. A total of 101 patients was analysed in whom Meniscal injury associated with ACL tear was noted. The patients were grouped into three based on the time from initial injury to the time of reconstruction. Acute injury (treated within 4 months of injury) sub-acute injury (treated between 4 and 8 months after injury) chronic injury (treated between 8 and 12 months after injury). The trend of meniscal injury based upon the injury to treatment time was analysed using appropriate statistical methods.

Results: Immediately following ACL injury lateral meniscal injuries were more common and was found in the acute phase. Lateral meniscus tears decreased as patients passed through the acute phase into the sub-acute phase, whereas medial meniscal tears began to increase and predominated in the chronic phase. Medial meniscal injuries were common in chronic ACL tears which were often complex tears not amenable to repair.

Conclusions: This study was able to demonstrate that the incidence of meniscal injury increased over time in ACL damaged knees.

 


Keywords


Anterior cruciate tear, ACL reconstruction, Meniscal tear, Medial meniscus, Lateral meniscus

Full Text:

PDF

References


Stone JA, Perrone GS, Nezwek TA. Delayed ACL reconstruction in patients ≥40 years of age is associated with increased risk of medial meniscal injury at 1 year. Am J Sports Med. 2019;47:584-9.

Noyes FR, Westin BSD. Treatment of meniscus tears during anterior cruciate ligament reconstruction. Arthroscopy. 2012;28:123-30.

Bray RC, Dandy DJ. Meniscal lesions and chronic anterior cruciate ligament deficiency. J Bone Joint Surg Br. 1989;71:128-30.

Maffulli N, Binfield PM, King JB. Articular Cartilage Lesions in the Symptomatic Anterior Cruciate Ligament-Deficient Knee. Arthroscopy 2003;19(7):685-90.

Kannus P, Jarvinen M. Conservatively treated tears of the anterior cruciate ligaments. J Bone Joint Surg Am. 1987;69:1007-12.

Lespasio MJ. Knee Osteoarthritis: A Primer.Perm J. 2017;21:16-183.

Jomha NM, Borton DC, Clingeleffer AJ, Pinczewski A. Long-term osteoarthritic changes in anterior cruciate ligament reconstructed knees. Clin Orthop Relat Res. 1999;358:188-93.

Keays SL, Newcombe PA, Saxton BJE, Bullock MI, Keays AC. Factors involved in the development of osteoarthritis after anterior cruciate ligament surgery. Am J Sports Med. 2010;38(3):455-63.

Fetto JE, Marshall JL. The natural history and diagnosis of anterior cruciate ligament insufficiency. Clin Orthop. 1980;147:29-38.

Gokeler A, Dingenen B, Mouton C, Seil R. Clinical course and recommendations for patients after anterior cruciate ligament injury and subsequent reconstruction A narrative review. EFORT Open Rev. 2017;2(10):410–20.

Shelbourne KD, Nitz PA. The O’Donoghue triad revisited combined knee injuries involving anterior cruciate and medial collateral ligament tears. Am J Sports Med. 1991;19:474-7.

Smith JP, Barrett GR. Medial and lateral meniscal tear patterns in anterior cruciate ligament-deficient knees. Am J Sports Med. 2001;29:415-9.

Howell R, Kumar NS, Patel N, Tom J. Degenerative meniscus: Pathogenesis, diagnosis, and treatment options. World J Orthop. 2014;5(5):597–602.

Aglietti P, Giron F, Cuomo P, Losco M, Mondanelli N. Single and double incision ACL reconstruction. Clin Orthop Relat Res. 2007;454:108-13.

Weber J, Koch M, Angele P, Zellner J. The role of meniscal repair for prevention of early onset of osteoarthritis. J Exp Orthop. 2018;5:10.

Porat VA, Roos EM, Roos H. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis. 2004;63(3):269-73.

Mehl J, Otto A, Baldino JB, Achtnich A. The ACL-deficient knee and the prevalence of meniscus and cartilage lesions: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2019;139(6):819-41.

Seon JK, Song EK, Park SJ. Osteoarthritis after anterior cruciate ligament reconstruction using a patellar tendon autograft. Int Orthop. 2006; 30(2):94-8.

Kullmer K, Letsch R, Turowski B. Which factors influence the progression of degenerative osteoarthritis after ACL surgery. Knee Surg Sports Traumatol Arthrosc. 1994;2(2):80-4.

Lohmander LS, Roos H. Knee ligament injury, surgery and osteoarthrosis. Acta Orthop Scand. 1994;65:605-9.

Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE. Treatment of anterior cruciate ligament injuries, part I. Am J Sports Med. 2005;33:1579-1602.

Nebelung W, Wuschech H. Thirty-five years of follow-up of anterior cruciate ligament deficient knees in high-level athletes. Arthroscopy. 2005;21:696-702.

Krause M, Freudenthaler F, Heinz KF. Operative Versus Conservative Treatment of Anterior Cruciate Ligament Rupture. Dtsch Arztebl Int. 2018;115(51-52):855-62.

Dunn WR, Lyman S, Lincoln AE, Amoroso PJ, Wickiewicz T, Marx RG. The effect of anterior cruciate ligament reconstruction on the risk of knee re injury. Am J Sports Med. 2004;32:1906-14.

Raines BT, Naclerio E, Sherman SL. Management of Anterior Cruciate Ligament Injury: What's In and What's Out? Indian J Orthop. 2017;51(5):563–75.

Tsujii A, Nakamura N, Horibe S. Age-related changes in the knee meniscus. Knee. 2017;24(6):1262-70.

Papastergiou, 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;15:9.

Keene G, Bickerstaff D, Paterson R. The natural history of meniscal tears in anterior cruciate ligament insufficiency. Am J Sports Med. 1993;21:672-9.

Aglietti P, Giron F, Cuomo P, Losco M, Mondanelli N. Single-and double-incision ACL reconstruction. Clin Orthop Relat Res. 2007;454:108-13.

Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE. Treatment of anterior cruciate ligament injuries, part I. Am J Sports Med. 2005;33:1579-1602.

Cohen M, Amaro JT, Ejnisman B, Carvalho RT, Nakano KK, Peccin MS, et al. Anterior cruciate ligament reconstruction after 10 to 15 years: association between meniscectomy and osteoarthrosis. Arthroscopy. 2007;23:629-34.

Jomha N, Borton D, Clingeleffer A, Pinczewski L. Long-term osteoarthritic changes in anterior cruciate ligament reconstructed knees. Clin Orthop Rel Res. 2008;358:188-93.

Lohmander LS, Roos H. Knee ligament injury, surgery and osteoarthrosis. Acta Orthop Scand. 1994;65:605-9.

Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries. Am J Sports Med. 2007;35:1756-69.