Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns

Journal of Orthopaedic Surgery and Research

Philipp Niemeyer¹  Norbert P Südkamp¹  David Dovi-Akue¹  Gian M Salzmann¹  Gerrit Bode¹  Sebastian Bigdon¹  Matthias J Feucht¹ 

[1] Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University of Freiburg, Hugstetter Straße 55, Freiburg, 79106, Germany

关键词: Contact injury;    Root tear;    Meniscus;    ACL;    Anterior cruciate ligament;   

Others  :  1171519
DOI  :  10.1186/s13018-015-0184-x

 received in 2015-01-27, accepted in 2015-03-04,  发布年份 2015

【 摘 要 】

Background

The pattern of lateral meniscus tears observed in anterior cruciate ligament (ACL)-injured subjects varies greatly and determines subsequent management. Certain tear patterns with major biomechanical consequences should be repaired in a timely manner. Knowledge about risk factors for such tears may help to identify patients in the early posttraumatic phase and subsequently may improve clinical results.

Methods

A database of 268 patients undergoing primary ACL reconstruction was used to identify all patients with isolated ACL tears and patients with an associated tear of the lateral meniscus. Patients who underwent surgery >6 months after the injury were excluded. Based on the arthroscopic appearance of the lateral meniscus, patients were assorted to one of three groups: ‘no tear,’ ‘minor tear,’ and ‘major tear.’ Tear patterns defined as major included root tears, complete radial tears, and unstable longitudinal tears including bucket-handle tears. Univariate analysis was performed by comparing the three groups with regard to gender, age, height, weight, BMI, type of injury (high-impact sport, low-impact sport, and not sports related), and mechanism of injury (non-contact vs. contact). Multivariate logistic regression was carried out to identify independent risk factors for minor and major meniscal tears and to calculate odds ratios (OR).

Results

Two hundred fifteen patients met the inclusion and exclusion criteria. Of those, 56% had isolated ACL tears, 27% had associated minor tears, and 17% had associated major tears of the lateral meniscus. Univariate analysis revealed significant differences between the three groups for gender (p = 0.002), age groups (p = 0.026), and mechanism of injury (p < 0.001). A contact injury mechanism was a risk factor for minor tears (OR: 4.28) and major tears (OR: 18.49). Additional risk factors for major tears were male gender (OR: 7.38) and age <30 years (OR: 5.85).

Conclusion

Male patients, patients <30 years, and particularly patients who sustained a contact injury have a high risk for an associated major lateral meniscus tear. Special attention is therefore necessary in those patients and early referral to magnetic resonance imaging and/or arthroscopy is recommended to allow meniscus repair in a timely manner.

【 授权许可】

   
2015 Feucht et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Noyes FR, Barber-Westin SD: Treatment of meniscus tears during anterior cruciate ligament reconstruction. Arthroscopy 2012, 28:123-30. doi:10.1016/j.arthro.2011.08.292
• [2]Wyatt RW, Inacio MC, Liddle KD, Maletis GB: Factors associated with meniscus repair in patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med 2013, 41:2766-71. doi:10.1177/0363546513503287
• [3]Smith JP 3rd, Barrett GR: Medial and lateral meniscal tear patterns in anterior cruciate ligament-deficient knees. A prospective analysis of 575 tears. Am J Sports Med 2001, 29:415-9.
• [4]Slauterbeck JR, Kousa P, Clifton BC, Naud S, Tourville TW, Johnson RJ, et al.: Geographic mapping of meniscus and cartilage lesions associated with anterior cruciate ligament injuries. J Bone Joint Surg Am 2009, 91:2094-103. doi:10.2106/JBJS.H.00888
• [5]Ghodadra N, Mall NA, Karas V, Grumet RC, Kirk S, McNickle AG, et al.: Articular and meniscal pathology associated with primary anterior cruciate ligament reconstruction. J Knee Surg 2013, 26:185-93. doi:10.1055/s-0032-1327450
• [6]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. 2013. doi:10.1007/s00167-013-2497-9.
• [7]Magnussen RA, Mansour AA, Carey JL, Spindler KP: Meniscus status at anterior cruciate ligament reconstruction associated with radiographic signs of osteoarthritis at 5- to 10-year follow-up: a systematic review. J Knee Surg 2009, 22:347-57.
• [8]Shelbourne KD, Gray T: Results of anterior cruciate ligament reconstruction based on meniscus and articular cartilage status at the time of surgery. Five- to fifteen-year evaluations. Am J Sports Med 2000, 28:446-52.
• [9]Oiestad BE, Engebretsen L, Storheim K, Risberg MA: Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. Am J Sports Med 2009, 37:1434-43. doi:10.1177/0363546509338827
• [10]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. doi:10.1016/j.arthro.2007.03.094
• [11]Cox CL, Huston LJ, Dunn WR, Reinke EK, Nwosu SK, Parker RD, et al.: Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study. Am J Sports Med 2014, 42:1058-67. doi:10.1177/0363546514525910
• [12]Shelbourne KD, Dersam MD: Comparison of partial meniscectomy versus meniscus repair for bucket-handle lateral meniscus tears in anterior cruciate ligament reconstructed knees. Arthroscopy 2004, 20:581-5. Doi: 10.1016/j.arthro.2004.03.009
• [13]Toman CV, Dunn WR, Spindler KP, Amendola A, Andrish JT, Bergfeld JA, et al.: Success of meniscal repair at anterior cruciate ligament reconstruction. Am J Sports Med 2009, 37:1111-5. doi:10.1177/0363546509337010
• [14]Cipolla M, Scala A, Gianni E, Puddu G: Different patterns of meniscal tears in acute anterior cruciate ligament (ACL) ruptures and in chronic ACL-deficient knees. Classification, staging and timing of treatment. Knee Surg Sports Traumatol Arthrosc 1995, 3:130-4.
• [15]Nikolic DK: Lateral meniscal tears and their evolution in acute injuries of the anterior cruciate ligament of the knee. Arthroscopic analysis. Knee Surg Sports Traumatol Arthrosc 1998, 6:26-30.
• [16]Keene GC, Bickerstaff D, Rae PJ, Paterson RS: The natural history of meniscal tears in anterior cruciate ligament insufficiency. Am J Sports Med 1993, 21:672-9.
• [17]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, 21:928-33. doi:10.1007/s00167-012-2027-1
• [18]Pujol N, Beaufils P: Healing results of meniscal tears left in situ during anterior cruciate ligament reconstruction: a review of clinical studies. Knee Surg Sports Traumatol Arthrosc 2009, 17:396-401. doi:10.1007/s00167-008-0711-y
• [19]Fitzgibbons RE, Shelbourne KD: “Aggressive” nontreatment of lateral meniscal tears seen during anterior cruciate ligament reconstruction. Am J Sports Med 1995, 23:156-9.
• [20]Shelbourne KD, Heinrich J: The long-term evaluation of lateral meniscus tears left in situ at the time of anterior cruciate ligament reconstruction. Arthroscopy 2004, 20:346-51. doi:10.1016/j.arthro.2004.01.029
• [21]Laprade CM, Jansson KS, Dornan G, Smith SD, Wijdicks CA, Laprade RF: Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs. J Bone Joint Surg Am 2014, 96:471-9. doi:10.2106/JBJS.L.01252
• [22]Forkel P, Herbort M, Sprenker F, Metzlaff S, Raschke M, Petersen W: The biomechanical effect of a lateral meniscus posterior root tear with and without damage to the meniscofemoral ligament: efficacy of different repair techniques. Arthroscopy 2014, 30:833-40. doi:10.1016/j.arthro.2014.02.040
• [23]Ode GE, Van Thiel GS, McArthur SA, Dishkin-Paset J, Leurgans SE, Shewman EF, et al.: Effects of serial sectioning and repair of radial tears in the lateral meniscus. Am J Sports Med 2012, 40:1863-70. doi:10.1177/0363546512453291
• [24]Schillhammer CK, Werner FW, Scuderi MG, Cannizzaro JP: Repair of lateral meniscus posterior horn detachment lesions: a biomechanical evaluation. Am J Sports Med 2012, 40:2604-9. doi:10.1177/0363546512458574
• [25]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, 41:2759-65. doi:10.1177/0363546513503448
• [26]Hewett TE, Shultz SJ, Griffin LY: Understanding and preventing noncontact ACL injuries. Human Kinetics, Champaign, IL; 2007.
• [27]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, 39:1894-9. doi:10.1177/0363546511410380
• [28]Piasecki DP, Spindler KP, Warren TA, Andrish JT, Parker RD: Intraarticular injuries associated with anterior cruciate ligament tear: findings at ligament reconstruction in high school and recreational athletes. An analysis of sex-based differences. Am J Sports Med 2003, 31:601-5.
• [29]Bowers AL, Spindler KP, McCarty EC, Arrigain S: Height, weight, and BMI predict intra-articular injuries observed during ACL reconstruction: evaluation of 456 cases from a prospective ACL database. Clin J Sport Med 2005, 15:9-13.
• [30]O’Connor DP, Laughlin MS, Woods GW: Factors related to additional knee injuries after anterior cruciate ligament injury. Arthroscopy 2005, 21:431-8. doi:10.1016/j.arthro.2004.12.004
• [31]Tandogan RN, Taser O, Kayaalp A, Taskiran E, Pinar H, Alparslan B, 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, 12:262-70. doi:10.1007/s00167-003-0398-z
• [32]Murrell GA, Maddali S, Horovitz L, Oakley SP, Warren RF: The effects of time course after anterior cruciate ligament injury in correlation with meniscal and cartilage loss. Am J Sports Med 2001, 29:9-14.
• [33]Millett PJ, Willis AA, Warren RF: Associated injuries in pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear? Arthroscopy 2002, 18:955-9.
• [34]Church S, Keating JF: Reconstruction of the anterior cruciate ligament: timing of surgery and the incidence of meniscal tears and degenerative change. J Bone Joint Surg (Br) 2005, 87:1639-42. doi:10.1302/0301-620X.87B12.16916
• [35]Yuksel HY, Erkan S, Uzun M: The evaluation of intraarticular lesions accompanying ACL ruptures in military personnel who elected not to restrict their daily activities: the effect of age and time from injury. Knee Surg Sports Traumatol Arthrosc 2006, 14:1139-47. doi:10.1007/s00167-006-0170-2
• [36]Dumont GD, Hogue GD, Padalecki JR, Okoro N, Wilson PL: Meniscal and chondral injuries associated with pediatric anterior cruciate ligament tears: relationship of treatment time and patient-specific factors. Am J Sports Med 2012, 40:2128-33. doi:10.1177/0363546512449994
• [37]Granan LP, Bahr R, Lie SA, Engebretsen L: Timing of anterior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: a cohort study based on the Norwegian National Knee Ligament Registry. Am J Sports Med 2009, 37:955-61. doi:10.1177/0363546508330136
• [38]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, 15:1438-44. doi:10.1007/s00167-007-0414-9
• [39]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. 2013. doi:10.1007/s00167-013-2718-2.
• [40]Magnussen RA, Pedroza AD, Donaldson CT, Flanigan DC, Kaeding CC: Time from ACL injury to reconstruction and the prevalence of additional intra-articular pathology: is patient age an important factor? Knee Surg Sports Traumatol Arthrosc 2013, 21:2029-34. doi:10.1007/s00167-013-2380-8
• [41]Beldame J, Wajfisz A, Lespagnol F, Hulet C, Seil R: Lateral meniscus lesions on unstable knee. Orthop Traumatol Surg Res 2009, 95:S65-9. doi:10.1016/j.otsr.2009.09.007
• [42]Binfield PM, Maffulli N, King JB: Patterns of meniscal tears associated with anterior cruciate ligament lesions in athletes. Injury 1993, 24:557-61.
• [43]Cerabona F, Sherman MF, Bonamo JR, Sklar J: Patterns of meniscal injury with acute anterior cruciate ligament tears. Am J Sports Med 1988, 16:603-9.
• [44]Bedi A, Kelly N, Baad M, Fox AJ, Ma Y, Warren RF, et al.: Dynamic contact mechanics of radial tears of the lateral meniscus: implications for treatment. Arthroscopy 2012, 28:372-81. doi:10.1016/j.arthro.2011.08.287
• [45]Barenius B, Ponzer S, Shalabi A, Bujak R, Norlen L, Eriksson K: Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial. Am J Sports Med 2014, 42:1049-57. doi:10.1177/0363546514526139
• [46]Wu WH, Hackett T, Richmond JC: Effects of meniscal and articular surface status on knee stability, function, and symptoms after anterior cruciate ligament reconstruction: a long-term prospective study. Am J Sports Med 2002, 30:845-50.
• [47]Tenuta JJ, Arciero RA: Arthroscopic evaluation of meniscal repairs. Factors that effect healing. Am J Sports Med 1994, 22:797-802.
• [48]De Smet AA, Graf BK: Meniscal tears missed on MR imaging: relationship to meniscal tear patterns and anterior cruciate ligament tears. AJR Am J Roentgenol 1994, 162:905-11. doi:10.2214/ajr.162.4.8141016
• [49]Jee WH, McCauley TR, Kim JM: Magnetic resonance diagnosis of meniscal tears in patients with acute anterior cruciate ligament tears. J Comput Assist Tomogr 2004, 28:402-6.
• [50]Laundre BJ, Collins MS, Bond JR, Dahm DL, Stuart MJ, Mandrekar JN: MRI accuracy for tears of the posterior horn of the lateral meniscus in patients with acute anterior cruciate ligament injury and the clinical relevance of missed tears. AJR Am J Roentgenol 2009, 193:515-23. doi:10.2214/AJR.08.2146
• [51]Granan LP, Inacio MC, Maletis GB, Funahashi TT, Engebretsen L: Sport-specific injury pattern recorded during anterior cruciate ligament reconstruction. Am J Sports Med 2013, 41:2814-8. doi:10.1177/0363546513501791