AJSM - 2026-03-31 - Journal Article
Prevalence of Medial Meniscus Injury After Delayed ACL Reconstruction.
Nickelberry C, Laxson S, Lapite IO, Haddock AT, Yim A, Abdul Rahman HQ, Nhem Z, Phan A, Yoo JU, Brady JM
Topics
Key Takeaway
Delayed ACL reconstruction (>120 days post-injury) increases odds of medial meniscus tears by 80% (aOR 1.80) and combined medial+lateral tears by 47% (aOR 1.47) across all age groups.
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Summary
This multicenter retrospective cohort examined whether surgery timing, age, sex, and activity level predict meniscal tear patterns at the time of ACL reconstruction in 2033 patients aged 9–73 years (2013–2023). Multivariable logistic regression identified >120 days from injury to surgery as the critical threshold, yielding 80% higher odds of medial meniscus tears and 47% higher odds of bilateral tears. Male sex independently increased odds of medial, lateral, and combined meniscal tears by 43%, 61%, and 50%, respectively, at all time points.
Key Limitation
The retrospective design relies on documented injury dates, which are frequently imprecise in clinical records, potentially misclassifying patients into early versus delayed surgery groups and biasing the primary outcome.
Original Abstract
BACKGROUND
The menisci serve as secondary stabilizers in the knee, and anterior cruciate ligament (ACL) tears have been associated with meniscal tears. Previous studies have indicated that a delay ≥12 months is associated with development of new meniscal pathology in an ACL-deficient knee. Some studies have indicated that the time period might be shorter in the pediatric and adolescent population, and other predictive factors remain poorly defined.
PURPOSE
To examine the association between time, patient-related factors, and the extent and location of meniscal pathology for patients of all ages with ACL reconstruction.
STUDY DESIGN
Cohort study (prognosis); Level of evidence, 3.
METHODS
This multicenter retrospective cohort analysis of 2033 patients with ACL reconstruction, aged 9 to 73 years, included those who underwent ACL reconstruction between 2013 and 2023. Multivariable logistic regression analysis was used to model meniscal tear patterns based on age, sex, activity level, and surgery interval.
RESULTS
Delayed ACL reconstruction (>120 days postinjury) was associated with a significantly higher prevalence of medial meniscus tears ( P < .001). Multivariable analyses revealed that delayed surgery increased the odds of medial meniscus tears by 80% (adjusted odds ratio [aOR], 1.80; 95% CI, 1.47-2.21; P < .001) and both medial and lateral tears by 47% (aOR, 1.47; 95% CI, 1.10-1.97; P < .009). Furthermore, male sex was associated with an elevated prevalence for meniscal tears at all time points compared to female sex, demonstrating 43% higher odds of medial meniscus tears (aOR, 1.43; 95% CI, 1.18-1.74; P < .001), 61% higher odds of lateral meniscus tears (aOR, 1.61; 95% CI, 1.34-1.93; P < .001), and 50% higher odds of both medial and lateral meniscus tears (aOR, 1.50; 95% CI, 1.13-1.98; P < .005).
CONCLUSION
These results highlight the importance of timely surgical management to mitigate progressive intra-articular damage, with special consideration for male athletes and patients at high risk for delayed intervention.