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

Abstract

Introduction

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.

Results

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.

Conclusion

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.

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Correspondence to Wolf Petersen.

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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.

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Appendix

Appendix

See Figs. 8, 9, 10, 11, 12 and 13.

Fig. 8
figure8

Analysis of the rate of any meniscus injury less and more than 6 months after ACL rupture. mo months; Inj number of meniscus injuries, Tot total number of patients

Fig. 9
figure9

Analysis of the rate of any meniscus injury less and more than 12 months after ACL rupture. mo months, Inj number of meniscus injuries, Tot total number of patients

Fig. 10
figure10

Analysis of the rate of medial meniscus injuries less and more than 6 months after ACL rupture. mo months, Inj number of meniscus injuries, Tot total number of patients

Fig. 11
figure11

Analysis of the rate of medial meniscus injuries less and more than 12 months after ACL rupture. mo months, Inj number of meniscus injuries, Tot total number of patients

Fig. 12
figure12

Analysis of the rate of any cartilage injury less and more than 6 months after ACL rupture. mo months, Inj number of cartilage injuries, Tot total number of patients

Fig. 13
figure13

Analysis of the rate of any cartilage injury less and more than 12 months after ACL rupture. mo months, Inj number of cartilage injuries, Tot total number of patients

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Mehl, J., Otto, A., Baldino, J.B. et al. The ACL-deficient knee and the prevalence of meniscus and cartilage lesions: a systematic review and meta-analysis (CRD42017076897). Arch Orthop Trauma Surg 139, 819–841 (2019). https://doi.org/10.1007/s00402-019-03128-4

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Keywords

  • Anterior cruciate ligament
  • Meniscus
  • Cartilage
  • Osteoarthritis
  • Partial meniscectomy
  • Arthroscopy