The ACL-deficient knee and the prevalence of meniscus and cartilage lesions: a systematic review and meta-analysis (CRD42017076897)

  • Julian Mehl
  • Alexander Otto
  • Joshua B. Baldino
  • Andrea Achtnich
  • Ralph Akoto
  • Andreas B. Imhoff
  • Sven Scheffler
  • Wolf PetersenEmail author
Arthroscopy and Sports Medicine



The purpose of this systematic review and meta-analysis was to analyze and compare the rate of secondary meniscus and cartilage lesions diagnosed at different time points of ACL reconstruction.

Materials and methods

A systematic search for articles comparing the rate of secondary meniscus and cartilage lesions diagnosed at different time points of ACL reconstruction was performed. PubMed central was the database used for the literature review.


Forty articles out of 1836 were included. In 35 trials (88%), there was evidence of a positive correlation between the rate of meniscus and/or cartilage lesions and the time since ACL injury. This correlation was more evident for the medial meniscus in comparison with the lateral meniscus. In particular, a delay of more than 6 months was critical for secondary medial meniscus injuries [risk ratio 0.58 (95% CI 0.44–0.79)] and a delay of more than 12 months was critical for cartilage injuries [risk ratio 0.42 (95% CI 0.29–0.59)]. Additionally, there is evidence that the chance for meniscal repair decreases as the time since ACL rupture increases.


Chronic instability in the ACL-deficient knee is associated with a significant increase of medial meniscus injuries after 6 months followed by a significant increase of cartilage lesions after 12 months.


Anterior cruciate ligament Meniscus Cartilage Osteoarthritis Partial meniscectomy Arthroscopy 



There is no funding source.

Compliance with ethical standards

Conflict of interest

JM, AA, RA, ABI, SS and WP are members of the ligament committee of the German knee society (DKG). ABI receives royalties from Arthrex and consultant fees from Arthrosurface and Medi Bayreuth outside the submitted work. SS receives personal fees from Smith & Nephew, Arthrex and Conmed/Linvatec outside the submitted work. WP receives consultant fees from Karl Storz endoscopy, AAP implants and Otto Bock health care. All other authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Abteilung für Sportorthopädie der TU MünchenKlinikum rechts der Isar der TUMunichGermany
  2. 2.Department of Orthopaedic SurgeryUniversity of ConnecticutFarmingtonUSA
  3. 3.Chirurgisch-Traumatologisches ZentrumHamburgGermany
  4. 4.SporthopaedicumBerlinGermany
  5. 5.Klinik für Orthopädie und Unfallchirurgie am Martin Luther KrankenhausBerlinGermany

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