The hidden cost of delay: meniscal and osteochondral damage in neglected ACL tears

Authors

  • Syeda S. Khaleel Department of Orthopaedics, Apollo Institute of Medical Sciences, Hyderabad, Telangana, India
  • Nagam K. Chandra Department of Orthopaedics, Apollo Institute of Medical Sciences, Hyderabad, Telangana, India
  • Goka R. Reddy Department of Orthopaedics, Apollo Institute of Medical Sciences, Hyderabad, Telangana, India
  • Soud S. Uddin Department of Orthopaedics, Apollo Institute of Medical Sciences, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20252630

Keywords:

Anterior cruciate ligament, Arthroscopy, Meniscal injury, Neglected, Osteochondral defects, Tegner

Abstract

Background: Neglected anterior cruciate ligament (ACL) tears cause repeated incidences of giving-way and rotational-translational instability. The effects of untreated ACL tears and its impact on the meniscus and cartilage was evaluated in this study over a two year time period, especially those with high Tegner activity levels, results in more severe and complicated meniscal and osteochondral lesions with potential affect on the outcome. The study emphasized the importance of early treatment of ACL injury to prevent damage to the meniscal and cartilaginous tissue and secondary osteoarthritis.

Methods: This study examined 385 patients who underwent arthroscopic ACL reconstruction between 2022 and 2024. Researchers analyzed arthroscopic findings, MRI scans, and patient records from the time of surgery. The focus was on identifying severe meniscal and osteochondral lesions that could adversely impact patient outcomes. These lesions were classified as meniscal lesions affecting outcome (MLAO) and osteochondral lesions affecting outcome (OLAO). The study also investigated statistical correlations between MLAO, OLAO, time since injury, and Tegner activity levels.

Results: The occurrence of MLAO and OLAO increased significantly as the duration between injury and surgery lengthened (p=0.001, p<0.05). However, no statistically significant correlation was found between the Tegner activity score and the risk of MLAO or OLAO (p=0.317, p=0.184, p>0.05).

Conclusions: A delay in ACL reconstruction can result in a higher occurrence of meniscal and osteochondral lesions, negatively influencing surgical results.

Metrics

Metrics Loading ...

Author Biography

Goka R. Reddy, Department of Orthopaedics, Apollo Institute of Medical Sciences, Hyderabad, Telangana, India

ASSISTANT PROFESSOR

DEPARTMENT OF ORTHOPAEDICS

References

Keyhani S, Esmailiejah AA, Mirhoseini MS, Hosseininejad SM, Ghanbari N. The prevalence, zone, and type of the meniscus tear in patients with Anterior Cruciate Ligament (ACL) injury; does delayed acl reconstruction affects the meniscal injury? Arch Bone Jt Surg. 2020;8(3):432-8.

Cain Jr EL, Fleisig GS, Ponce BA, Boohaker HA, George MP, McGwin Jr G, et al. Variables associated with chondral and meniscal injuries in anterior cruciate ligament surgery. J Knee Surg. 2017;30(07):659-67. DOI: https://doi.org/10.1055/s-0036-1593875

Michalitsis S, Vlychou M, Malizos KN, Thriskos P, Hantes ME. 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. 2015;23(1):232-9. DOI: https://doi.org/10.1007/s00167-013-2497-9

Anderson AF, Anderson CN. Correlation of meniscal and articular cartilage injuries in children and adolescents with timing of anterior cruciate ligament reconstruction. Am J Sports Med. 2015;43(2):275-81. DOI: https://doi.org/10.1177/0363546514559912

Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985;198:43-9. DOI: https://doi.org/10.1097/00003086-198509000-00007

Jeevan MP, John JT. Effects of neglected anterior cruciate ligament tears on medial and lateral meniscus. Inter J Res Orthopaed. 2020;6(4):687. DOI: https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20202568

Gomoll AH, Farr J, Gillogly SD, Kercher J, Minas T. Surgical management of articular cartilage defects of the knee. J Bone Joint Surg Am. 2010;92:2470-90.

Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43:752. DOI: https://doi.org/10.1302/0301-620X.43B4.752

Nukuto K, Konstantinou E, Wackerle AM, Lagreca JC, Grandberg C, Park YL, et al. Meniscus tears in the setting of anterior cruciate ligament injury. J Joint Surg Res. 2024;2(4):180-8. DOI: https://doi.org/10.1016/j.jjoisr.2024.10.003

Ahldén M, Samuelsson K, Sernert N, Forssblad M, Karlsson J, Kartus J. The Swedish National Anterior Cruciate Ligament Register: a report on baseline variables and outcomes of surgery for almost 18,000 patients. Amer J Sports Medi. 2012;40(10):2230-5. DOI: https://doi.org/10.1177/0363546512457348

Church S, Keating JF. Reconstruction of the anterior cru ciate ligament: timing of surgery and the incidence of meniscal tears and degenerative change. J Bone Joint Surg Br. 2005;87:1639-42. DOI: https://doi.org/10.1302/0301-620X.87B12.16916

Foster A, Butcher C, Turner PG. Changes in arthroscopic findings in the anterior cruciate ligament deficient knee prior to reconstructive surgery. Knee. 2005;12:33-5. DOI: https://doi.org/10.1016/j.knee.2003.10.007

Indelicato PA, Bittar ES. A perspective of lesions associ ated with ACL insufficiency of the knee. A review of 100 cases. Clin Orthop. 1985;198:77-80. DOI: https://doi.org/10.1097/00003086-198509000-00011

Demirağ B, Aydemir F, Daniş M, Ermutlu C. Incidence of meniscal and osteochondral lesions in patients undergoing delayed anterior cruciate ligament reconstruction. Acta Orthop Traumatol Turc. 2011;45(5):348-52.

Robb C, Kempshall P, Getgood A, Standell H, Sprowson A, Thompson P, Spalding T. Meniscal integrity predicts laxity of anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2015;23(12):3683-90. DOI: https://doi.org/10.1007/s00167-014-3277-x

Brambilla L, Pulici L, Carimati G, Quaglia A, Prospero E, Bait C, Morenghi E, Portinaro N, Denti M, Volpi P. Prevalence of associated lesions in anterior cruciate ligament reconstruction: correlation with surgical timing and with patient age, sex, and body mass index. Am J Sports Med. 2015;43(12):2966-73. DOI: https://doi.org/10.1177/0363546515608483

Noyes FR, Barber-Westin SD. Treatment of meniscus tears during anterior cruciate ligament reconstruction. Arthroscopy. 2012;28(1):123-30. DOI: https://doi.org/10.1016/j.arthro.2011.08.292

Mansori AE, Lording T, Schneider A, Dumas R, Servien E, Lustig S. Incidence and patterns of meniscal tears accompanying the anterior cruciate ligament injury: possible local and generalized risk factors. Inter Orthopaed. 2018;42:2113-21. DOI: https://doi.org/10.1007/s00264-018-3992-x

Weber J, Koch M, Angele P, Zellner J. The role of meniscal repair for prevention of early onset of osteoarthritis. J Exp Orthop. 2018;5:10. DOI: https://doi.org/10.1186/s40634-018-0122-z

Porat VA, Roos EM, Roos H. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis. 2004;63(3):269-73. DOI: https://doi.org/10.1136/ard.2003.008136

Mehl J, Otto A, Baldino JB, Achtnich A. The ACL deficient knee and the prevalence of meniscus and cartilage lesions: a systematic review and meta analysis. Arch Orthop Trauma Surg. 2019;139(6):819-41. DOI: https://doi.org/10.1007/s00402-019-03128-4

Seon JK, Song EK, Park SJ. Osteoarthritis after anterior cruciate ligament reconstruction using a patellar tendon autograft. Int Orthop. 2006;30(2):94-8. DOI: https://doi.org/10.1007/s00264-005-0036-0

Kullmer K, Letsch R, Turowski B. Which factors influence the progression of degenerative osteoarthritis after ACL surgery. Knee Surg Sports Traumatol Arthrosc. 1994;2(2):80-4. DOI: https://doi.org/10.1007/BF01476477

Gillquist J, Messner K. Anterior cruciate ligament recon struction and the long-term incidence of gonarthrosis. Sports Med. 1999;27:143-56. DOI: https://doi.org/10.2165/00007256-199927030-00001

Downloads

Published

2025-08-25

How to Cite

Khaleel, S. S., Chandra, N. K., Reddy, G. R., & Uddin, S. S. (2025). The hidden cost of delay: meniscal and osteochondral damage in neglected ACL tears . International Journal of Research in Orthopaedics, 11(5), 1061–1065. https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20252630

Issue

Section

Original Research Articles