Low meniscus reoperation rates following meniscus repair during anterior cruciate ligament reconstruction in Turkey: an in-depth national analysis of 8-years.

BACKGROUND: Concomitant knee injuries, such as meniscal tears, are observed in up to 80% of cases and can have a detrimental impact on outcomes following anterior cruciate ligament reconstruction (ACLR). Over recent decades, there has been a growing recognition of the importance of preserving meniscal tissue. Consequently, the prevalence of meniscal-preserving procedures has been on the rise. PURPOSE: The objective of this study was to examine the prevalence of concurrent meniscal procedures, assess the success rate, and identify factors associated with the failure of meniscal repair in patients undergoing ACLR. METHODS: All patients who underwent ACLR due to anterior cruciate ligament (ACL) injury between January 2015 and December 2022 were extracted from the Republic of Türkiye National health system using operation-specific procedure codes. Patients with multiple ligament injuries, revision ACL patients, and patients with missing data were excluded from the study. The treatment methods were grouped into the subsets of meniscectomy, meniscal repair, transplantation, and meniscectomy + repair. The distribution of ACLR and meniscus treatment methods according to years, age and sex groups, hospital characteristics, and geographical regions was examined. A secondary analysis was performed to assess the effect of patient demographics and hospital healthcare level on revision meniscal procedures in the ACLR + concomitant meniscal repair group. RESULTS: A total of 91,700 patients who underwent ACLR between 2015 and 2022 were included in the study. A concomitant meniscal procedure was noted in 19,951(21.8%) patients (16,130 repair,3543 meniscectomy). In the 8 years studied, meniscus repair rates increased from 76.3%to87.9%, while meniscectomy rates decreased from 23.7%to12.1% (p < 0.001). The revision meniscus surgery rate following ACLR + meniscal repair was 3.7%at a mean follow-up of 50 ± 26 months. The interval between primary and revision surgery was 20.5 ± 21.2 months. The meniscectomy rates were higher in community hospitals, while private hospitals showed the lowest revision meniscus surgery rates. Younger age was associated with increased meniscus repair failure rates. CONCLUSION: The propensity towards using repair techniques to treat meniscal tears during concurrent ACLR has significantly increased in Turkey. Age and the healthcare level of the treating hospital affect the success of meniscal repair.

Segond fracture: an indicator for increased risk of lateral meniscus injury in patients with acute anterior cruciate ligament ruptures.

PURPOSE: The purpose of this study was to investigate the incidence and anatomic distribution of meniscus injury in patients who have sustained acute ACL injuries with and without concomitant Segond fracture. We hypothesized that patients who have sustained a torn ACL with a concomitant Segond fracture would have a higher incidence of lateral meniscal injuries than patients with an isolated ACL injury. METHODS: Patients who underwent ACL reconstruction from 2012 to 2022 were retrospectively reviewed. Segond fractures were identified on knee radiographs. Inclusion criteria were age 18-40, injury during sports activity, and reconstruction within 90 days of injury. Sports activity, anatomic location of meniscus injury, and meniscus treatment were documented. Multivariable regression was used to identify predictors of meniscus injury/treatment. RESULTS: There were 25 of 603 (4.1%) patients who had an ACL tear with concomitant Segond fracture. The incidence of lateral meniscus injury in the Segond group (72%) was significantly higher than in the non-Segond cohort (49%; p = 0.024). A significantly smaller proportion of medial meniscus injuries among patients with Segond fractures were repaired (23.1%) compared to the non-Segond group (54.2%; p = 0.043). Multivariate analysis found patients with Segond fractures to have increased odds of lateral meniscus injury (OR 2.68; [1.09, 6.60], p = 0.032) and were less likely to have medial meniscus injuries repaired (OR 0.35; [0.15, 0.81], p = 0.014). Additionally, males had increased odds of lateral meniscus injury (OR 1.54; [1.08 - 2.91], p = 0.017), which were more likely to require repair (OR 1.48; [1.02, 2.14], p = 0.038). CONCLUSIONS: Among acute ACL injuries, the incidence of lateral meniscus injury is greater among patients with Segond fractures. Patients with Segond fracture were less likely to undergo repair of medial meniscal injuries.

Incidence of and Risk Factors for Medial Meniscal Lesions at the Time of ACL Reconstruction: An Analysis of 4697 Knees From the SANTI Study Group Database.

BACKGROUND: Medial meniscal (MM) lesions (MMLs) are a common finding at the time of anterior cruciate ligament reconstruction (ACLR). It is recognized that evaluation of the posteromedial compartment reduces the rate of missed MML diagnoses. PURPOSE: To determine the incidence of MMLs in patients undergoing ACLR, when using a standardized arthroscopic approach that included posteromedial compartment evaluation, as well as to determine how the incidence of MMLs changed with increasing time intervals between injury and surgery, and to investigate what risk factors were associated with their presence. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective analysis of prospectively collected data was performed. All patients who underwent primary ACLR between January 2013 and March 2023 were considered for study eligibility. The epidemiology was defined by categorizing and reporting the incidence and categorizing the spectrum of MM tear types. Risk factors associated with MMLs were analyzed using a logistic regression model. RESULTS: MMLs were identified in 1851 (39.4%) of 4697 consecutive patients undergoing ACLR. The overall incidence of MMLs was 33.1% for the period of 0 to 3 months, 38.7% for the period of 3 to 12 months, and 59.6% for the period of >12 months. The overall incidence of MMLs increased with longer durations of time between injury and surgery, along with significant increases in complex, bucket-handle, ramp, and/or flap lesions. The largest increase in incidence of MMLs was observed for complex MM tear patterns. Risk factors associated with MMLs included time between injury and surgery >3 months (odds ratio [OR], 1.320; 95% CI, 1.155-1.509; P < .0001) and >12 months (OR, 3.052; 95% CI, 2.553-3.649; P < .0001), male sex (OR, 1.501; 95% CI, 1.304-1.729; P < .0001), body mass index (BMI) ≥25 (OR, 1.193; 95% CI, 1.046-1.362; P = .0088), and lateral meniscal lesion (OR, 1.737; 95% CI, 1.519-1.986; P < .0001). CONCLUSION: Overall, MMLs were identified in 39.4% of 4697 patients undergoing ACLR when posteromedial compartment evaluation was performed in addition to standard anterior viewing. The incidence of MMLs and the complexity of tear types increased significantly with increasing time intervals between the index injury and ACLR. Secondary risk factors associated with an increased incidence of medial meniscal tears include male sex, increased BMI, and lateral meniscal lesions.

Posterolateral tibial plateau bone bruises in anterior cruciate ligament (ACL) injuries and its association with lateral meniscal injuries.

INTRODUCTION: This study examined the prevalence of posterolateral tibial bone bruising in isolated anterior cruciate ligament (ACL) injuries, prevalence of meniscal injuries in ACL injuries, as well as the association between posterolateral tibial bone bruising and lateral meniscal tears among those with ACL injury undergoing Primary ACL Reconstruction. MATERIALS AND METHODS: Retrospective data on 130 patients who underwent primary ACL reconstructions was analysed. Their preoperative magnetic resonance images (MRI) were reviewed for the presence of posterolateral tibial bone bruise. The presence of meniscal injuries was recorded based on the arthroscopic findings from the operative records. RESULTS: 95 patients were recruited into the study. The prevalence of posterolateral bone bruise in this study was 41%. There was a statistically significant difference when comparing the prevalence of bone bruising to the time of injury to MRI (p<0.001). The prevalence of an injury to at least one meniscus at the time of ACLR surgery was 83.2%. The prevalence of lateral meniscus injuries in patients with bone bruise was found to be 53.9%. The crude odds ratio of a patient having a lateral meniscal tear in the presence of bone bruising was 1.56 (0.68, 3.54). This figure was even higher when it was adjusted for time to MRI and was 2.06 (0.77, 5.46). CONCLUSION: Prevalence of posterolateral tibial bone bruising in our study was 41%, and the prevalence of meniscal injury to either meniscus at the point of surgery was 83.2%, out of which the lateral meniscus tears were identified during ACLR surgery in 47.3% of the patients. We found there was no association between posterolateral tibial bone bruising to sex, age and mode of injury, but was sensitive to the interval between time of injury and MRI. The overall prevalence of lateral meniscal tears was higher in patients with posterolateral bone bruising but was not statistically significant with a P value of 0.31; however, the Crude odd ratio was 1.56 (0.68, 3.54) and was higher when adjusted to time of injury to MRI 2.06 (0.77, 5.46). We suggest for MRI to be done as soon as possible after injury in regard to bone bruising identification. We should be vigilant to look for lateral meniscal tears and anticipate for its repair in ACL injuries, especially so when we identify posterolateral tibial bruising on the preoperative MRI.

Meniscal rim instability has a high prevalence and a variable location.

INTRODUCTION: Most classification systems for lateral discoid meniscus do not evaluate instability of the meniscal peripheral rim. Considerable variability in the prevalence of peripheral rim instability has been published, and it appears that instability is underestimated. The purpose of this study was: first, to evaluate the prevalence of peripheral rim instability and its location in the symptomatic lateral discoid meniscus, and second, to investigate if patient age or type of discoid meniscus are possible risk factors for instability. METHODS: A cohort of 78 knees that underwent operative treatment due to symptomatic discoid lateral meniscus was analyzed retrospectively for the rate and location of peripheral rim instability. RESULTS: Out of the 78 knees, 57.7% (45) had a complete and 42.3% (33) had an incomplete lateral meniscus. The prevalence of peripheral rim instability in symptomatic lateral discoid menisci was 51.3%, and with 32.5%, the anterior attachment was most commonly affected, followed by the posterior (30%) and central (10%) attachment. 27.5% of the tested menisci were unstable anteriorly and posteriorly. There was no significant difference in the prevalence of rim instability between the type of discoid menisci (complete vs. incomplete), nor was there a significant correlation for age as a risk factor for instability. CONCLUSION: The discoid lateral meniscus has a high prevalence and variable location of peripheral rim instability. Meniscal rim stability must be tested and addressed cautiously in all parts and in all types of discoid lateral menisci during operative treatment.

Factors Associated With Meniscal and Articular Cartilage Injury in the PLUTO Cohort.

BACKGROUND: Anterior cruciate ligament (ACL) injuries in adults are frequently accompanied by meniscal and articular cartilage damage. However, little is known regarding the association, if any, between physical maturity, hypermobility, or bone bruising and these associated injuries in skeletally immature patients with ACL tears. PURPOSE: To determine if physical maturity, hypermobility, and/or bone bruising is associated with concomitant meniscal and articular cartilage injury in skeletally immature patients with ACL tears. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: At 10 institutions in the United States, consecutive skeletally immature patients with complete ACL tears were enrolled between January 2016 and June 2020. Univariable and multivariable logistic regression analysis was used to assess the effect of variables on the likelihood of articular cartilage and meniscal injury. RESULTS: A total of 748 patients were analyzed. Of these, 85 patients (11.4%) had articular cartilage injuries. These patients had a higher bone age (13.9 vs 13.1 years; P = .001), a higher Tanner stage (P = .009), and increased height (162.9 vs 159.9 cm; P = .03) and were heavier (57.8 vs 54.0 kg; P = .02). For each additional Tanner stage, the odds of articular cartilage injury increased approximately 1.6 times (P < .001). Of the total patients, 423 (56.6%) had meniscal tears. Those with meniscal tears were older (12.6 vs 12.0 years; P < .001), had a higher bone age (13.5 vs 12.8 years; P < .001), had a higher Tanner stage (P = .002), had increased height (162.2 vs 157.6 cm; P < .001), and were heavier (56.6 vs 51.6 kg; P < .001). For each additional Tanner stage, the odds of a meniscal tear increased approximately 1.3 times (P < .001). No association was detected between hypermobility or bone bruising and the likelihood of articular cartilage or meniscal injury. Multivariable regression revealed that increasing Tanner stage was associated with an increasing risk of articular cartilage injury, while weight was associated with an increasing risk of meniscal injury. CONCLUSION: Increasing physical maturity is associated with increased risks of concomitant articular cartilage and meniscal injury in skeletally immature patients with ACL tears. Hypermobility and bone bruising are not associated with articular cartilage or meniscal injury, suggesting that physical maturity, rather than ligamentous laxity, is the primary risk factor for associated injuries in skeletally immature patients with an ACL tear.

High prevalence of meniscal ramp lesions in anterior cruciate ligament injuries.

PURPOSE: To evaluate the prevalence of and factors associated with meniscal ramp lesions on magnetic resonance imaging (MRI) in patients with anterior cruciate ligament (ACL) injuries. METHODS: Data from the Natural Corollaries and Recovery after ACL injury multicentre longitudinal cohort study (NACOX) were analysed. Only patients who underwent MRI were included in this study. All MRI scans were reviewed by an orthopaedic knee surgeon and a musculoskeletal radiologist. The patients were divided into two groups, those with and without ramp lesions according to MRI findings. Univariable and stepwise forward multiple logistic regression analyses were used to evaluate patient characteristics (age, gender, body mass index, pre-injury Tegner activity level, activity at injury) and concomitant injuries on MRI (lateral meniscus, medial collateral ligament [MCL], isolated deep MCL, lateral collateral ligament, pivot-shift-type bone bruising, posteromedial tibial [PMT] bone bruising, medial femoral condyle bone bruising, lateral femoral condyle [LFC] impaction and a Segond fracture) associated with the presence of meniscal ramp lesions. RESULTS: A total of 253 patients (52.2% males) with a mean age of 25.4 ± 7.1 years were included. The overall prevalence of meniscal ramp lesions was 39.5% (100/253). Univariate analyses showed that contact sports at ACL injury, pivot-shift-type bone bruising, PMT bone bruising, LFC impaction and the presence of a Segond fracture increased the odds of having a meniscal ramp lesion. Stepwise forward multiple logistic regression analysis revealed that the presence of a meniscal ramp lesion was associated with contact sports at ACL injury [odds ratio (OR) 2.50; 95% confidence intervals (CI) 1.32-4.72; P = 0.005], pivot-shift-type bone bruising (OR 1.29; 95% CI 1.01-1.67; P = 0.04), PMT bone bruising (OR 4.62; 95% CI 2.61-8.19; P < 0.001) and the presence of a Segond fracture (OR 4.38; 95% CI 1.40-13.68; P = 0.001). CONCLUSION: The overall prevalence of meniscal ramp lesions in patients with ACL injuries was high (39.5%). Contact sports at ACL injury, pivot-shift-type bone bruising, PMT bone bruising and the presence of a Segond fracture on MRI were associated with meniscal ramp lesions. Given their high prevalence, meniscal ramp lesions should be systematically searched for on MRI in patients with ACL injuries. Knowledge of the factors associated with meniscal ramp lesions may facilitate their diagnosis, raising surgeons' and radiologists' suspicion of these tears. LEVEL OF EVIDENCE: III.

Increased Time to Surgery After Anterior Cruciate Ligament Tear in Female Patients Results in Greater Risk of Medial Meniscus Tear: A Study of 489 Female Patients.

PURPOSE: This study assessed the incidence of meniscal tears in anterior cruciate ligament (ACL)-deficient knees, considering the time between injury and reconstruction in a large sample of female patients. Furthermore, we evaluated whether the rate of meniscal repair or meniscectomy was affected by age and body mass index (BMI). METHODS: The medical records of 489 patients who underwent ACL-reconstructive surgery between January 2011 and April 2021 were analyzed to collect data on the prevalence of meniscal tears, surgical timing, patient age, and BMI. Logistic regression was performed to estimate the association between the prevalence of meniscal tears and the independent variables of surgical timing, age, and BMI. RESULTS: Between 24 and 60 months after their injury, female patients showed a statistically significant increase in the presence of associated meniscal lesions when compared with ACL reconstruction performed earlier (odds ratio [OR] of 3.11; 95% 1.06-9.10 confidence interval [CI]), especially for medial meniscal tears, with an OR of 1.94 (95% CI 1.23-3.05, P = .004) between 12 and 24 months. There is a statistically significant difference after 12 months in the rate of meniscal suturing for medial meniscus tears (OR 3.30; CI 1.37-7.91 P = .007). Increasing age was associated with a greater prevalence of meniscal tears up to 30-50 years, but there was no clear association between BMI and associated lesions other than a greater rate of meniscectomies. CONCLUSIONS: In female patients who experienced an ACL injury, a delay in surgery greater than 12 months is associated with a gradual increase in the risk of nonrepairable medial meniscal tear; this risk becomes statistically significant after 24 months. A high BMI does not seem to have relevance in the onset of associated lesions in women but results in a greater rate of meniscectomies compared with meniscal sutures, whereas age between 30 and 50 years is associated with a greater risk of associated injuries. LEVEL OF EVIDENCE: III, retrospective comparative prognostic trial.

Ramp Tear among Patients Undergoing Arthroscopic Anterior Cruciate Ligament Reconstruction in a Tertiary Care Centre.

Introduction: Ramp tear is a specific injury that affects the posterior horn of the medial meniscus and its meniscosynovial or meniscocapsular attachments. The actual prevalence of ramp lesion is unknown due to the high probability of misdiagnosis or underdiagnosis caused by the low sensitivity of imaging modalities and poor visualization during arthroscopy. This study aimed to find out the prevalence of ramp tear among patients undergoing arthroscopic anterior cruciate ligament reconstruction in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among patients undergoing arthroscopic anterior cruciate ligament reconstruction after getting ethical approval from the Institutional Review Committee. Data from 1 March 2019 to 31 December 2022 was collected between 1 May 2023 to 30 May 2023 from medical records. The study included all patients who underwent arthroscopic anterior cruciate ligament reconstruction. Patients with a previous history of medial meniscus injury or repair and undergoing revision anterior cruciate ligament reconstruction were excluded. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Out of 412 patients who underwent arthroscopic anterior cruciate ligament reconstruction, 53 (12.86%) (9.63-16.09, 95% Confidence Interval) had ramp tears. The mean age of patients with ramp tears was 28.64±7.57 years. Among 53 patients, 42 (79.24%) were male and 11 (20.75%) were female. Conclusions: The prevalence of ramp tears in patients undergoing arthroscopic anterior cruciate ligament reconstruction in a tertiary care centre was found to be lower than other studies done in other international studies. Keywords: anterior cruciate ligament injuries; anterior cruciate ligament reconstruction; arthroscopy.

Declining trends in arthroscopic meniscus surgery and other arthroscopic knee procedures in Denmark: a nationwide register-based study.

BACKGROUND AND PURPOSE: A doubling of arthroscopic meniscal procedures was observed in Denmark from 2000 to 2011, but arthroscopic meniscal procedures for degenerative meniscal tears are no longer recommended. We performed an updated investigation of Danish meniscal procedure trends in the private and public healthcare sectors in Denmark from 2006 to 2018, including trends for other arthroscopic knee procedures. PATIENTS AND METHODS: We extracted data on the 5 most commonly registered arthroscopic knee procedures (diagnostic arthroscopy, meniscal surgery, anterior cruciate ligament reconstruction, synovectomy, and cartilage resection) from the Danish National Patient Register from January 1, 2006 to December 31, 2018, linked with the Danish Population Statistic Register, to obtain data on age and sex. RESULTS: 414,253 arthroscopic knee procedures were registered during 315,290 surgeries on 244,113 individual patients in the study period. For meniscal procedures, the highest incidence was observed in 2010 (319 per 105 persons/year, 95% CI 314-323) and the lowest in 2018 (173 per 105 persons/year, CI 169-176), corresponding to relative decrease of 46% from 2010 to 2018. Remaining arthroscopic procedures also showed declining trends, with lowest incidence for all procedures in 2018. INTERPRETATION: A large decrease in the incidence for arthroscopic meniscal procedures was observed from 2010 to 2018, possibly in response to mounting evidence of limited benefit of this procedure for degenerative knee disease. All other investigated arthroscopic knee procedures also declined in the same period.

Influence of Sex, Race/Ethnicity, and Socioeconomic Factors on Meniscal Treatment With Pediatric and Adolescent ACL Reconstruction.

BACKGROUND: The rate of anterior cruciate ligament (ACL) reconstruction is increasing over time in pediatric/adolescent populations, but there is less evidence to support how concomitant meniscal procedures are changing over time. There are also less data to suggest which characteristics are associated with meniscectomy versus meniscal repair treatment. HYPOTHESIS: Age, sex, race/ethnicity, income, and insurance type may independently affect the rate of concomitant meniscal procedures and treatment modalities in pediatric patients with ACL reconstruction. STUDY DESIGN: Descriptive epidemiology study. METHODS: The Pediatric Health Information System database was queried for all patients aged ≤18 years who underwent ACL reconstruction with or without concomitant meniscal procedures from 2015 to 2019. Basic demographic data including age, sex, self-identified race/ethnicity, rural-urban commuting area code, predicted median income, and insurance status were collected. Linear regression was used to model trends and multiple logistic regression modeling was used to test for associations. RESULTS: A total of 14,398 patients aged ≤18 years underwent ACL reconstruction during the study period, with 8337 patients (58%) having concomitant meniscal procedures with a 1.24-fold increase over 5 years. Of the concomitant meniscal treatment cohort, 41% had a meniscectomy and 59% had meniscal repair. There was a 0.82-fold change in meniscectomy and a 1.67-fold increase in meniscal repair during the study period. Male patients, older patients, Black race, living in an urban area, and those with nonprivate insurance had increased odds of undergoing a concomitant meniscal procedure (all P < .05). Patients of non-White race and those with nonprivate insurance had increased odds of having a meniscectomy versus meniscal repair (all P < .05). There were no associations detected between income bracket and the outcomes in this study. CONCLUSION: This study shows that in pediatric and adolescent patients undergoing ACL reconstruction, there was a rise in concomitant meniscal procedures from 2015 to 2019. In addition, patients of non-White race and those with nonprivate insurance have increased odds of undergoing meniscectomy versus meniscal repair.

Prevalence and Incidence of Chondral and Meniscal Lesions in Patients Undergoing Primary and Subsequent Revision Anterior Cruciate Ligament Reconstruction: An Analysis of 213 Patients From the SANTI Group.

BACKGROUND: Previous studies have shown a higher prevalence of meniscal and chondral lesions at the time of revision anterior cruciate ligament reconstruction (R-ACLR) compared with primary ACLR procedures. However, studies that follow the development of meniscal and chondral status through primary and subsequent R-ACLR are scarce. PURPOSE: To compare the prevalence of meniscal and chondral injuries in patients undergoing primary ACLR and subsequent R-ACLR. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients who underwent ACLR and subsequently needed R-ACLR between January 2009 and February 2018 in a single center were included. A retrospective analysis of prospectively collected data was conducted. RESULTS: A total of 213 patients were included, with a mean follow-up of 59.7 months. The mean age was 22 years at primary ACLR and 26.1 years at the time of revision. The proportion of meniscal tears was higher at the time of R-ACLR compared with the time of primary reconstruction (70.0% vs 44.6%, respectively; P < .001). Similarly, the prevalence of chondral lesions was significantly higher at the time of revision versus the primary reconstruction (15.5% vs 7.0%, respectively; P = .003). CONCLUSION: R-ACLR is associated with a higher rate of concomitant meniscal and chondral lesions than primary ACLR.

Isolated meniscus injuries in skeletally immature children and adolescents: state of the art.

The prevalence of isolated meniscal injuries in children and adolescents is low; however, we see an increase mainly due to intensified sports-related activities at an early age. A meniscal repair should be attempted whenever possible as children present with increased meniscal healing potential. The diagnosis and management of meniscal tears involve both patient factors and tear characteristics: size, anatomical location and associated injuries. Special attention should be given to the feature of discoid menisci and related tears as they require a specific management plan. This state-of-the-art review highlights the most recent studies on clinical evaluation, surgical techniques, tips and tricks, pitfalls, outcomes, return-to-sports, geographical differences and future perspectives related to meniscal injuries in children and adolescents.

Epidemiology of Combined Injuries of the Secondary Stabilizers in ACL-Deficient Knees: Medial Meniscal Ramp Lesion, Lateral Meniscus Root Tear, and ALL Tear: A Prospective Case Series of 602 Patients With ACL Tears From the SANTI Study Group.

BACKGROUND: Medial meniscal ramp lesion (MMRL), lateral meniscus root tear (LMRT), and anterolateral ligament (ALL) tear are individual injuries that have been described in patients who have an anterior cruciate ligament (ACL) tear. However, the prevalence of these lesions and their combination has not been defined. PURPOSES: To define the individual and combined prevalence of MMRL, LMRT, and ALL tears in a case series of patients undergoing ACL reconstruction and to identify the risk factors for combined injuries. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Patients aged >15 years undergoing primary ACL reconstruction between January 2019 and June 2021 were enrolled in the study. A preoperative ultrasound scan was performed to look for an ALL tear. The presence of MMRL and LMRT was determined during a standardized arthroscopy exploration. A multivariate logistic regression model was used to determine the individual effect of patient variables on the risk of associated single, dual, triad, or tetrad injuries (MMRL, LMRT, ALL, ACL), represented by an adjusted odds ratio. RESULTS: The case series consisted of 602 patients who underwent primary ACL reconstruction. An isolated ACL injury was present in 147 patients (24%). A dual injury was detected in 34 patients (6%) who had ACL-MMRL, 16 (2.65%) who had ACL-LMRT, and 265 (44%) who had ACL-ALL. A triad injury was detected in 80 patients (13.28%) who had ACL-ALL-MMRL, 36 (6%) who had ACL-ALL-LMRT, and 3 (0.5%) who had ACL-MMRL-LMRT. A tetrad injury pattern was detected in 21 patients (3.5%). Multivariate analysis showed that the occurrence of tetrad injury was significantly lower in older patients (adjusted odds ratio by year, 0.93 [95% CI, 0.88-0.99]; P = .028). Identifying LMRT increased the likelihood of finding MMRL-ALL injuries by 2.11 times (95% CI, 1.09-3.12; P = .031). CONCLUSION: Isolated ACL tear is less common than combined injuries, which are quite frequent. Younger age is a risk factor for combined injuries. The search for damaged secondary stabilizers of the knee must be meticulous and systematic, especially when 1 injured structure has already been diagnosed.

Epidemiology of Meniscus Injuries in the Military Health System and Predictive Factors for Arthroscopic Surgery.

Meniscus injuries occur at a higher rate in the military than the general population. Appropriate management and rehabilitation of meniscus injuries is important for maintaining readiness. The purpose of this study was to describe the health burden of meniscus injuries in the Military Health System (MHS) to identify the surgical intervention rate for meniscus injuries, and to determine which injury characteristics and demographic variables were associated with the likelihood of surgery after injury. The U.S. Department of Defense Management Analysis and Reporting Tool, a database of health care encounters by military personnel and dependents, was queried for encounters associated with a meniscal injury diagnosis between January 1, 2010, and December 31, 2011. Meniscus injuries were categorized into (1) isolated medial, (2) isolated lateral, (3) combined medial and lateral, and (4) unspecified cohorts. Patients under 18 and over 51 years were excluded, as well as patients without records at least 1 year prior to diagnosis or 2 years after. Relevant surgical procedures were identified with the Current Procedural Terminology (CPT) codes for arthroscopic surgery of the knee, meniscus repair, meniscectomy, and anterior cruciate ligament (ACL) reconstruction. There were 2,969 meniscus injuries meeting inclusion criteria during the study period. There were 1,547 (52.1%) isolated medial meniscus injuries, 530 (17.9%) isolated lateral meniscus injuries, 452 (15.3%) involved both menisci, and 435 (14.7%) were unspecified. The mean age was 35.5 years (standard deviation [SD] = 9.3). An adjacent ligamentous injury occurred in 901 patients (30.3%). The treatment course led to arthroscopic surgery in 52.8% (n = 1,568) of all meniscus injuries. Eighty-five percent (n = 385) of combined medial and lateral tears, 54.9% of medial tears, and 51.6% of lateral tears underwent surgery. Partial meniscectomy was the most common procedure performed while 47.2% (n = 1,401) of tears were not treated surgically. Bilateral meniscus injuries had 4.57 greater odds of undergoing knee arthroscopy (95% confidence interval [CI]: 3.46, 6.04), 2.42 times odds of undergoing a meniscus repair, and 4.59 times odds for undergoing a meniscus debridement (95% CI: 3.62, 5.82). The closed nature of the MHS allows reliable capture of surgical rates for meniscus injuries within the military population. Meniscus injuries are common in the military and impose a significant burden on the MHS. Appropriate management and rehabilitation of this injury is important for maintaining readiness.

The prevalence and parameters of fabella and its association with medial meniscal tear in China: a retrospective study of 1011 knees.

BACKGROUND: Fabella is a sesamoid bone of knee that has potential biomechanical function. We aimed to examine the fabellar prevalence and parameters in Chinese population and test the hypothesis that fabellar presence and morphology were associated with meniscus tear or ligament injury. METHODS: A total of 1011 knee magnetic resonance imaging scans from 979 patients with knee pain were analyzed retrospectively. The exclusion criteria are postsurgical scans, difficulty in fabella discrimination, conditions not suitable for measurement, and unsatisfied image. The fabellar presence and its parameters (length, width and thickness) were documented. The association between fabellar presence and meniscus tear or ligament injury were assessed by chi-square test, in all knees and subgroups (age, gender, side, lesion part). The correlation of fabellar presence and parameters with advancing age was assessed by Spearman correlation analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to investigate whether factors related with meniscus tear or ligament injury. Diagnostic performance of risk factors was assessed by receiver operating characteristic (ROC) analysis. RESULTS: The overall prevalence of fabellae was 39.8% (402/1011 knees) and increased with the increasing age (r = 0.237, P < 0.001). The size of the fabellae differed according to genders, age, and presence of articulating grooves. Fabella presented more often in knees with medial meniscus (MM) tears (66.7% vs 33.8%; P < 0.001) with a multivariate OR of 2.960 (95% CI, 1.853-3.903). The association remained in all tear parts (anterior, middle, and posterior), and in younger (age < 50 years) and older patients (age ≥ 50 years). Age, fabellar length, width, length/thickness ratio and width/thickness ratio yielded an area under the ROC curve (AUC) of 0.604-0.766 to predict an MM tear. In combination with age, fabellar width and length/thickness ratio, the AUC was improved 0.791 (95% CI, 0.744-0.837), with a sensitivity of 73.0% and a specificity of 74.6%. CONCLUSION: The presence of fabellae, increased fabellar length and width as well as flatter fabellar morphology, are significantly associated with an increased risk for MM tear. These findings might aid clinicians in identifying patients at risk for a MM tear and informing them.

Meniscal Preservation is More Likely When Performed with Acute Anterior Cruciate Ligament Repair Rather Than with Anterior Cruciate Ligament Reconstruction.

INTRODUCTION: Rupture of the anterior cruciate ligament (ACL) often occurs in conjunction with meniscal tears. In this study, we investigate the rates and outcomes of meniscal repair surgery performed with ACL reconstruction compared with acute ACL repair surgery. MATERIALS AND METHODS: Data was collected for all patients undergoing surgery for ACL ruptures between 2012 and 2018, including ACL reconstruction with hamstring autograft and primary ACL repair augmented with suture tape. Patients undergoing multi-ligament surgery were excluded. Meniscal injury was evaluated intraoperatively and the treatment was determined by type of tear, reducibility, and quality of meniscal tissue. If possible, tears were repaired using all-inside anchors and all others were resected. RESULTS: There were 272 ACL reconstructions and 134 ACL repairs, and mean age was 28 (±9) and 35 (±14) years, respectively (p <0.01). The mean Tegner activity score was 6.6 in both groups. The mean interval from injury to surgery was longer in the reconstruction group (26.2 vs. 1.3 months, p <0.01). Fifty-five percent of reconstructions and 43% of ACL repairs required meniscal surgery at the time of their ACL procedure. In the reconstruction group, 123 (70%) were meniscectomies and 53 (30%) were meniscal repairs, compared to 31 (50%) of each in the ACL repair group. Meniscal repair was more likely to be possible when carried out as part of acute ACL repair surgery, c2(1, n=238)=7.94, p <0.01. The success rate of meniscal repair was 97% in both groups. CONCLUSIONS: The rate of meniscal repair is 67% higher when performed early with ACL repair. When ACL reconstruction is performed, meniscal resection was more likely. Rates of post-traumatic osteoarthritis are high after ACL reconstruction when performed with meniscal resection. Furthermore, the success rate of meniscal repair in conjunction with ACL surgery is high (97%). Therefore, meniscal repair should be encouraged whenever possible to improve long-term outcomes.

Prevalence of anterolateral ligament injuries and lateral meniscus tear on MR imaging in patients with both-bundle tear vs. selective bundle incomplete tear of the anterior cruciate ligament.

OBJECTIVES: We investigated the prevalence of anterolateral ligament (ALL) injury and lateral meniscus (LM) tear in cases with both-bundle tear and selective bundle incomplete tear of the anterior cruciate ligament (ACL). METHODS: A total of 174 cases of magnetic resonance (MR) images that had an ACL tear and underwent arthroscopic ACL reconstruction were retrospectively reviewed. ACL injury was classified into both bundle, anteromedial bundle, and posterolateral bundle (PL) on arthroscopic finding. The ALL was divided into three portions: femoral, meniscal, and tibial. ALL injury was scored into three groups: grade 0 is intact; grade 1 is stranding and edema surrounds the expected location of the ALL; grade 2 is clear discontinuity of the ALL consistent with rupture. Traumatic LM tear was also assessed on MR images. RESULTS: The total prevalence of ALL injury was 36.2% (reader 1) and 42.0% (reader 2). ALL injury was statistically related to the selective bundle tear (p = 0.002 and 0.004, readers 1 and 2). PL bundle tear was significantly correlated with the ALL injury (p value < 0.001, readers 1 and 2, both). The location and grade of ALL injury were not significantly correlated with the type of ACL injury. LM tear was not significantly related to the types of ACL tear (p = 0.208 and 0.907, readers 1 and 2) and ALL injury (p value = 0.096 and 0.383, readers 1 and 2). CONCLUSIONS: ALL injury was significantly related to the PL bundle tear of the ACL. LM tear was not significantly correlated with the types of ACL injury and ALL injury. KEY POINTS: • Anterolateral ligament (ALL) injury was significantly related to the posterolateral bundle (PL) tear of the anterior cruciate ligament (ACL). • Lateral meniscus (LM) tear was not significantly correlated with the types of ACL injury and ALL injury. • Clinicians and radiologists should be aware of these relationships and scrutinize ALL injury in cases with PL bundle tears, even with an incomplete ACL injury.

The Epidemiology of Meniscus Injury.

Meniscus surgery is one of the most commonly performed orthopedic procedures worldwide. Modifiable risk factors for meniscus injury include body mass index, participation in athletics and occupation. Nonmodifiable risk factors include age, sex, lower extremity alignment, discoid meniscus, ligamentous laxity, and biconcave tibial plateau. Conditions commonly associated with meniscal injury are osteoarthritis, anterior cruciate ligament injury, and tibial plateau fractures. Tear type and location vary by patient age and functional status. Surgical management of meniscus injury is typically cost-effective in terms of quality-adjusted life years. The purpose of this review is to provide an overview of meniscal injury epidemiology by summarizing tear types and locations, associated conditions, and factors that increase the risk for meniscal injury. The economic burden of meniscus injury and strategies to prevent injury to the meniscus are also reviewed.