Journal of Orthopedics & Rheumatology
Patterns of Meniscal Damage Associated with Acute ACL Rupture
Al Saran Y, Al Lhaidan A, Al Garni N, Al Aqeel M , Alomar A, Bin Nasser A, Fawzi Alassir* and Mohammed Zamzam
- Orthopedic Research Chair, King Saud University, Riyadh, Saudi Arabia
*Address for Correspondence: Fawzi Fahad Al Jassir, Professor and Consultant Orthopedic Surgeon, Knee and Shoulder Reconstruction and Orthopedic Oncology, Department of Orthopedics (49), King Khalid University Hospital and College of Medicine, King Saud University, P.O. Box 7805, Riyadh 11472, Kingdom of Saudi Arabia, Tel: 966-1-4670871; Fax: 966-1-4679436; Email: firstname.lastname@example.org
Citation: Al Saran Y, Al Lhaidan A, Al Garni N, Al Aqeel M , Alomar A, et al. Patterns of Meniscal Damage Associated with Acute ACL Rupture. J Orthopedics Rheumatol. 2014;2(1): 4.
Copyright © 2014 Saran YA, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use,distribution, and reproduction in any medium, provided the original work is properly cited.
Journal of Orthopedics & Rheumatology | ISSN: 2334-2846 | Volume: 1, Issue: 2
Submission: 02 January 2014 | Accepted: 20 February 2014 | Published: 24 February 2014
Reviewed & Approved by: Bashir A. Zikria, Johns Hopkins Department of Orthopaedics, Division of Sports Medicine, USA
AbstractBackground/Aim: Meniscal injuries commonly occur in conjunction with ACL tears. This study was conducted to determine the patterns of meniscus damage associated with ACL rupture and identify the commonest type of meniscus damage in our population that is associated with ACL tear.
KeywordsAnterior cruciate ligament; Tear; Meniscus; Rupture; Patterns
IntroductionAnterior cruciate ligament (ACL), as a primary stabilizing structure of knee is the most common disrupted ligament in acute trauma in the US every year [1,2]. On the other hand, the menisci play a crucial role in the dynamics of the knee. Their shape, attachment, and material properties contribute substantially to joint alignment and load transmission by distributing both tensile and compressive forces. Damage to the menisci can influence proprioception, stability, and mobility of the knee [3,4]. Risk factors for meniscal tears include prolonged or repeated deep knee bending, obesity, and sports . Acute injury, as seen in alpine sports, involves complex dynamics, which can damage singular or multiple tissue structures of the knee [5,6]. Meniscal tears are typically thought to be initiated by coupled compression and twisting movements [7,8] which can accompany high-energy maneuvers such as cutting, jumping, and landing during sporting events .
MethodsMedical records of patients with ACL rupture covering a period of 16 years (January 1996 to December 2012) seen at the author’s institute were retrospectively reviewed. The collected data included the presence or absence of meniscal tear, the type of meniscal tear diagnosed by MRI or arthroscopy, the time of the initial ACL injury and the time of meniscal tear, the duration between ACL rupture and reconstruction surgery, age, gender, mode of injury and level of sports activity performed, height, weight.
ResultsA total of 294 patients satisfied the inclusion criteria of the current study from 1996 to 2012. Of these patients, 175 (59.5%) had MMTs, 91 (31%) had LMTs and 28 patients (9.5%) with both MMT and LMT (Table 1).
Table 1: Demographic characteristics of all patients with ACL rupture with meniscus injury.
Age in years, mean (SD)
Weight in kg, mean (SD)
Height in cm, mean (SD)
BMI in kg/cm2, mean (SD)
Mode of injury
Direct injury, n (%)
Non-direct injury, n (%)
Professional athletes, n (%)
Recreational athletes, n (%)
Non-athlete, n (%)
No available data, n (%)
Patients who had MMTs were significantly older (29.10 ± 7.0 years) compared to lateral (26.24 ± 5.9 years) and both (26.61 ± 6.7 years), p=0.002.
Table 2: Comparison between MMT, LMT and both in 294 patients who hadACL tear.
Age in years, mean (SD)
Weight in kg. mean (SD)
Height in cm, mean (SD)
BMI, mean (SD)
Obesity, n (%)
Type of ACL tear
Direct ACL tear, n (%)
Indirect ACL tear, n (%)
Level of sports
Recreational athlete, n (%)
Professional athlete, n (%)
Note: ^ by ANOVA, * by Chi-square test
Types of Meniscal Tears
DiscussionIn our study, the patients who had medial meniscal tearing were significantly older than those who had only lateral meniscal tear, and those who had both medial and lateral meniscal tears. No such relationship was significant between age and lateral meniscal tear. Our findings are in concordance with the findings of the study that was conducted in Turkey by Tandogan et al. , which showed preponderant injury to the medial meniscus than the lateral meniscus, they also found that the mean age of the patients with medial meniscal tears was 27.0 ± 7.6 years, significantly older than those who had no medial meniscal tearing (25.4 ± 6.7 years). Our patient’s mean age who had medial meniscal tearing was 29.10 ± 7.0 years, significantly older than 26.61 ± 6.7 years in those who did not have medial meniscal tearing. Sports level was not significantly correlated to the parameters we have studied or to the site of meniscal tear. This is probably because most of our patients (66.8%) were just recreational athletes.
ConclusionThe higher occurrence of medial meniscal tear in acute anterior cruciate tears could be attributed to the age related arthritic changes as well as to the common varus deformity in our population; this finding should be considered by the surgeons in order to decrease future osteoarthritis.
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