International Orthopaedics

, Volume 42, Issue 9, pp 2113–2121 | Cite as

Incidence and patterns of meniscal tears accompanying the anterior cruciate ligament injury: possible local and generalized risk factors

  • Ashraf EL Mansori
  • Timothy Lording
  • Antoine Schneider
  • Raphael Dumas
  • Elvire Servien
  • Sebastien LustigEmail author
Original Paper


Aim of the work

Injury to the anterior cruciate ligament (ACL) is frequently accompanied by tears of the menisci. Some of these tears occur at the time of injury, but others develop over time in the ACL-deficient knee. The aim of this study was to evaluate the effects of the patient characteristics, time from injury (TFI), and posterior tibial slope (PTS) on meniscal tear patterns. Our hypothesis was that meniscal tears would occur more frequently in ACL-deficient knees with increasing age, weight, TFI, PTS, and in male patients.


Of the ACL-injured patients, 362 were analyzed, and details of meniscal lesions were collected. The medial and lateral tibial slopes (MTS, LTS) were measured via computed tomography. Patient demographics, TFI, MTS, and LTS were correlated with the diagnosed meniscal tears.


Of the patients, 113 had a medial meniscus (MM) tear, 54 patients had a lateral meniscus (LM) tear, 34 patients had tears of both menisci, and 161 patients had no meniscal tear. The most common tear location was the posterior horn (PH) of the MM, followed by tear involving the whole MM. Patient age, BMI, and TFI were significantly associated with the incidence of MM tear. Female patients had a higher incidence of injury than males in all tear sites except in the body and PH. Male patients had more vertical and peripheral tears. The median MTS and LTS for patients with MM tears were 7.0°and 8.7°, respectively, while those of patients with LM tears were 6.9° and 8.1°. Steeper LTS was significantly associated with tears of LM and of both menisci.


Older age, male sex, increased BMI, and prolonged TFI were significant factors for the development of MM tears. An increase in the tibial slope, especially of the lateral plateau, seems to increase the risk of tear of the LM and of both menisci.

Level of evidence: Level III.


Knee ACL injury Meniscus tear Tibial slope Time from injury 



There is no funding source.

Compliance with ethical standards

Conflict of interest

AE, TL, AS, and RD declare no conflict of interest. ES is the consultant for Smith & Nephew, institutional research support from Corin and Amplitude. SL is the consultant for Smith & Nephew, institutional research support from Corin and Amplitude.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


  1. 1.
    Butler DL, Noyes FR, Grood ES (1980) Ligamentous restraints to anterior-posterior drawer in the human knee: a biomechanical study. J Bone Joint Surg Am 62(2):259–270CrossRefPubMedGoogle Scholar
  2. 2.
    Feucht MJ, Bigdon S, Bode G, Salzmann GM, Dovi-Akue D, Südkamp NP, Niemeyer P (2015) Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns. J Orthop Surg Res 10:34CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Papageorgiou CD, Gil JE, Kanamori A, Fenwick JA, Woo SL, Fu FH (2001) The biomechanical interdependence between the anterior cruciate ligament replacement graft and the medial meniscus. Am J Sports Med 29(2):226–231CrossRefPubMedGoogle Scholar
  4. 4.
    Chen G, Tang X, Li Q, Zheng G, Yang T, Li J (2015) The evaluation of patient-specific factors associated with meniscal and chondral injuries accompanying ACL rupture in young adult patients. Knee Surg Sports Traumatol Arthrosc 23(3):792–798CrossRefPubMedGoogle Scholar
  5. 5.
    Ford GM, Hegmann KT, White GL Jr, Holmes EB (2005) Associations of body mass index with meniscal tears. Am J Prev Med 28(4):364–368CrossRefPubMedGoogle Scholar
  6. 6.
    Michalitsis S, Vlychou M, Malizos KN, Thriskos P, Hantes ME (2015) 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 23(1):232–239CrossRefPubMedGoogle Scholar
  7. 7.
    Papastergiou SG, Koukoulias NE, Mikalef P, Ziogas E, Voulgaropoulos H (2007) Meniscal tears in the ACL-deficient knee: correlation between meniscal tears and the timing of ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 15(12):1438–1444CrossRefPubMedGoogle Scholar
  8. 8.
    Tandogan RN, Taşer O, Kayaalp A, Taşkiran E, Pinar H, Alparslan B, Alturfan A (2004) 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 12(4):262–270CrossRefPubMedGoogle Scholar
  9. 9.
    Anderson AF, Irrgang JJ, Dunn W, Beaufils P et al (2011) Interobserver reliability of the International Society of Arthroscopy, knee surgery and Orthopaedic sports medicine (ISAKOS) classification of meniscal tears. Am J Sports Med 39(5):926–932CrossRefPubMedGoogle Scholar
  10. 10.
    Lustig S, Scholes CJ, Leo SP, Coolican M, Parker DA (2013) Influence of soft tissues on the proximal bony tibial slope measured with two-dimensional MRI. Knee Surg Sports Traumatol Arthrosc 21:372–379CrossRefPubMedGoogle Scholar
  11. 11.
    Zhang Y, Wang J, Xiao J, Zhao L, Li ZH, Yan G, Shi ZJ (2014) Measurement and comparison of tibial posterior slope angle in different methods based on three-dimensional reconstruction. Knee 21(3):694–698CrossRefPubMedGoogle Scholar
  12. 12.
    Ghodadra N, Mall NA, Karas V, Grumet RC, Kirk S, McNickle AG, Garrido CP, Cole BJ, Bach BR Jr (2013) Articular and meniscal pathology associated with primary anterior cruciate ligament reconstruction. J Knee Surg 26(3):185–193CrossRefPubMedGoogle Scholar
  13. 13.
    Levy IM, Torzilli PA, Warren RF (1982) The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am 64(6):883–888CrossRefPubMedGoogle Scholar
  14. 14.
    Smith JP, Barrett GR (2001) Medial and lateral meniscal tear patterns in anterior cruciate ligament-deficient knees. A prospective analysis of 575 tears. Am J Sports Med 29(4):415–419CrossRefPubMedGoogle Scholar
  15. 15.
    Guenther ZD, Swami V, Dhillon SS, Jaremko JL (2014) Meniscal injury after adolescent anterior cruciate ligament injury: how long are patients at risk? Clin Orthop Relat Res 472(3):990–997CrossRefPubMedGoogle Scholar
  16. 16.
    Cerabona F, Sherman MF, Bonamo JR, Sklar J (1988) Patterns of meniscal injury with acute anterior cruciate ligament tears. Am J Sports Med 16(6):603–609CrossRefPubMedGoogle Scholar
  17. 17.
    Harper KW, Helms CA, Lambert HS 3rd, Higgins LD (2005) Radial meniscal tears: significance, incidence, and MR appearance. AJR Am J Roentgenol 185(6):1429–1434CrossRefPubMedGoogle Scholar
  18. 18.
    Choi CJ, Choi YJ, Song IB, Choi CH (2011) Characteristics of radial tears in the posterior horn of the medial meniscus compared to horizontal tears. Clin Orthop Surg 3(2):128–132CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Boyd KT, Myers PT (2003) Meniscus preservation: rationale, repair techniques and results. Knee 10(1):1–11CrossRefPubMedGoogle Scholar
  20. 20.
    O'Connor DP, Laughlin MS, Woods GW (2005) Factors related to additional knee injuries after anterior cruciate ligament injury. Arthroscopy 21(4):431–438CrossRefPubMedGoogle Scholar
  21. 21.
    Paletta GA Jr, Levine DS, O'Brien SJ, Wickiewicz TL, Warren RF (1992) Patterns of meniscal injury associated with acute anterior cruciate ligament injury in skiers. Am J Sports Med 20(5):542–547CrossRefPubMedGoogle Scholar
  22. 22.
    Yüksel HY, Erkan S, Uzun M (2006) 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 14(11):1139–1147CrossRefPubMedGoogle Scholar
  23. 23.
    Petersen W, Tillmann B (1995) Age-related blood and lymph supply of the knee menisci: a cadaver study. Acta Orthop Scand 66(4):308–312CrossRefPubMedGoogle Scholar
  24. 24.
    Takahashi M, Suzuki M, Kushida K, Hoshino H, Inoue T (1998) The effect of aging and osteoarthritis on the mature and senescent cross-links of collagen in human meniscus. Arthroscopy 14(4):366–372CrossRefPubMedGoogle Scholar
  25. 25.
    Jerosch J, Castro WHM, Assheuer J (1996) Age-related magnetic resonance imaging morphology of the menisci in asymptomatic individuals. Arch Orthop Trauma Surg 115(3–4):199–202CrossRefPubMedGoogle Scholar
  26. 26.
    Fok AW, Yau WP (2013) Delay in ACL reconstruction is associated with more severe and painful meniscal and chondral injuries. Knee Surg Sports Traumatol Arthrosc 21(4):928–933CrossRefPubMedGoogle Scholar
  27. 27.
    Piasecki DP, Spindler KP, Warren TA, Andrish JT, Parker RD (2003) 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 31(4):601–605CrossRefPubMedGoogle Scholar
  28. 28.
    Huston LJ, Wojtys EM (1996) Neuromuscular performance characteristics in elite female athletes. Am J Sports Med 24(4):427–436CrossRefPubMedGoogle Scholar
  29. 29.
    Bowers AL, Spindler KP, McCarty EC, Arrigain S (2005) 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 15(1):9–13CrossRefPubMedGoogle Scholar
  30. 30.
    Church S, Keating JF (2005) Reconstruction of the anterior cruciate ligament: timing of surgery and the incidence of meniscal tears and degenerative change. J Bone Joint Surg Br 87(12):1639–1642CrossRefPubMedGoogle Scholar
  31. 31.
    Joseph C, Pathak SS, Aravinda M, Rajan D (2008) Is ACL reconstruction only for athletes? A study of the incidence of meniscal and cartilage injuries in an ACL-deficient athlete and non-athlete population: an Indian experience. Int Orthop 32(1):57–61CrossRefPubMedGoogle Scholar
  32. 32.
    Keene GC, Bickerstaff D, Rae PJ, Paterson RS (1993) The natural history of meniscal tears in anterior cruciate ligament insufficiency. Am J Sports Med 21(5):672–679CrossRefPubMedGoogle Scholar
  33. 33.
    Gadeyne S, Besse JL, Galand-Desme S, Lerat JL, Moyen B (2006) Analysis of meniscal lesions accompanying anterior cruciate ligament tears: a retrospective analysis of 156 patients. Rev Chir Orthop Reparatrice Appar Mot 92(5):448–454CrossRefPubMedGoogle Scholar
  34. 34.
    Alici T, Esenyel CZ, Esenyel M, Imren Y, Ayanoglu S, Cubuk R (2011) Relationship between meniscal tears and tibial slope on the tibial plateau. Eurasian J Med 43(3):146–151CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Lee JJ, Choi YJ, Shin KY, Choi CH (2011) Medial meniscal tears in anterior cruciate ligament-deficient knees: effects of posterior tibial slope on medial meniscal tear. Knee Surg Relat Res 23(4):227–230CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Markl I, Zantop T, Zeman F, Seitz J, Angele P (2015) The effect of tibial slope in acute ACL-insufficient patients on concurrent meniscal tears. Arch Orthop Trauma Surg 135(8):1141–1149CrossRefPubMedGoogle Scholar
  37. 37.
    Simon RA, Everhart JS, Nagaraja HN, Chaudhari AM (2010) A case-control study of anterior cruciate ligament volume, tibial plateau slopes and intercondylar notch dimensions in ACL-injured knees. J Biomech 43(9):1702–1707CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Musahl V, Citak M, O'Loughlin PF, Choi D, Bedi A, Pearle AD (2010) The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 38(8):1591–1597CrossRefPubMedGoogle Scholar
  39. 39.
    Khan N, McMahon P, Obaid H (2014) Bony morphology of the knee and non-traumatic meniscal tears: is there a role for meniscal impingement? Skelet Radiol 43(7):955–962CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Ashraf EL Mansori
    • 1
    • 2
  • Timothy Lording
    • 3
  • Antoine Schneider
    • 2
  • Raphael Dumas
    • 1
  • Elvire Servien
    • 2
  • Sebastien Lustig
    • 1
    • 2
    Email author
  1. 1.Laboratoire de Biomécanique et Mécanique des ChocsUniversité Claude Bernard Lyon 1 – IFSTTARVilleurbanneFrance
  2. 2.Orthopaedic Surgery DepartmentLyon Croix Rousse University HospitalLyonFrance
  3. 3.Melbourne Orthopaedic GroupMelbourneAustralia

Personalised recommendations