Clinical Orthopaedics and Related Research®

, Volume 472, Issue 3, pp 990–997 | Cite as

Meniscal Injury After Adolescent Anterior Cruciate Ligament Injury: How Long Are Patients at Risk?

  • Zachary D. Guenther
  • Vimarsha Swami
  • Sukhvinder S. Dhillon
  • Jacob L. Jaremko
Clinical Research



Delay of as much as 5 months between ACL injury and surgery is known to be associated with increased risk of a medial meniscal tear, but the risk of additional meniscal tear progression with a longer delay to surgery is unclear.


We determined the (1) times of injury, MRI, and surgery in adolescents with ACL tears, and whether (2) timing of surgery, or (3) initial integrity of the meniscus seen on MR images predicted development of meniscal tears.


We reviewed 112 adolescents who were 15 ± 1 years old (mean ± SD) (range, 11–16 years) with a torn ACL. These patients underwent surgical repair from 2005 to 2011 in a Canadian city. We compared dates of injury, MRI, and surgery. A pediatric and musculoskeletal fellowship-trained radiologist reread the MR images, and meniscal injuries were graded according to severity. This was compared with surgical findings described in the operative report.


Time after injury to MRI and surgery averaged 77 days (range, 1–377 days) and 342 days (range, 42–1637 days), respectively. Patients with new or worsened medial meniscal tears had waited longer for surgery (445 versus 290 days; p = 0.002). Bucket handle medial meniscal tears were more common in patients with surgery more than 1 year after injury than others (15 of 34 versus 14 of 75; p = 0.013). A medial meniscal tear observed on MR images was a significant covariate for a torn meniscus at surgery (relative risk, 5.7; 95% CI, 2.8–11.6). Medial meniscal survival continued to decline sharply greater than 1 year after injury.


Medial meniscal tears, especially bucket handle tears, increased steadily in frequency more than 1 year after ACL injury. Timely ACL reconstruction may be warranted to reduce the risk of further medial meniscal damage even in patients whose original injury occurred more than 1 year before.

Level of Evidence

Level IV, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.


Lateral Meniscus Medial Meniscus Meniscal Tear Meniscal Injury Medial Meniscal Tear 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Zachary D. Guenther
    • 1
  • Vimarsha Swami
    • 1
  • Sukhvinder S. Dhillon
    • 1
  • Jacob L. Jaremko
    • 1
  1. 1.Department of Radiology and Diagnostic ImagingUniversity of AlbertaEdmontonCanada

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