Meniscal injury in isolated anterior cruciate ligament insufficiency

In this retrospective study the meniscal status of 34 patients with untreated complete anterior cruciate ligament (ACL) tears is reported. The anterior cruciate ligament injury was initially documented by examination under anesthesia and arthroscopy. Treatment in all cases consisted of a standard protocol of early rehabilitation and bracing. The mean follow-up was 7.3 years. Twenty-two (65%) patients showed signs of meniscal pathology at an average of 2.5 years after the ACL injury during the follow-up period. Rearthroscopy was performed and showed a higher incidence of medial meniscus tears (53%) than lesions of the lateral meniscus (41%). The most common tear of the medial meniscus was the bucket-handle type, followed by the flap tear and the single longitudinal split of the posterior horn. Secondary reconstruction of the ACL was necessary in 18 patients (82%) complaining of symptoms indicative of permanent anterior instability of the knee. The remaining 4 patients had rearthroscopy 3.5 years after the ACL injury and a partial meniscectomy and ACL reconstruction was performed. 12 patients (35%) had no symptoms or signs of joint instability or meniscal pathology during the follow-up period, but discontinued their sporting activities. This study indicates the increasing incidence of meniscal tears during ACL insufficiency. We recommend that patients with ruptures of the anterior cruciate ligament should be investigated for meniscal tears and that early ligament reconstruction of the knee and meniscal repair or partial meniscectomy should be considered simultaneously.