Limits...
Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns.

Feucht MJ, Bigdon S, Bode G, Salzmann GM, Dovi-Akue D, Südkamp NP, Niemeyer P - J Orthop Surg Res (2015)

Bottom Line: A database of 268 patients undergoing primary ACL reconstruction was used to identify all patients with isolated ACL tears and patients with an associated tear of the lateral meniscus.Of those, 56% had isolated ACL tears, 27% had associated minor tears, and 17% had associated major tears of the lateral meniscus.Special attention is therefore necessary in those patients and early referral to magnetic resonance imaging and/or arthroscopy is recommended to allow meniscus repair in a timely manner.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany. matthias.feucht@gmx.net.

ABSTRACT

Background: The pattern of lateral meniscus tears observed in anterior cruciate ligament (ACL)-injured subjects varies greatly and determines subsequent management. Certain tear patterns with major biomechanical consequences should be repaired in a timely manner. Knowledge about risk factors for such tears may help to identify patients in the early posttraumatic phase and subsequently may improve clinical results.

Methods: A database of 268 patients undergoing primary ACL reconstruction was used to identify all patients with isolated ACL tears and patients with an associated tear of the lateral meniscus. Patients who underwent surgery >6 months after the injury were excluded. Based on the arthroscopic appearance of the lateral meniscus, patients were assorted to one of three groups: 'no tear,' 'minor tear,' and 'major tear.' Tear patterns defined as major included root tears, complete radial tears, and unstable longitudinal tears including bucket-handle tears. Univariate analysis was performed by comparing the three groups with regard to gender, age, height, weight, BMI, type of injury (high-impact sport, low-impact sport, and not sports related), and mechanism of injury (non-contact vs. contact). Multivariate logistic regression was carried out to identify independent risk factors for minor and major meniscal tears and to calculate odds ratios (OR).

Results: Two hundred fifteen patients met the inclusion and exclusion criteria. Of those, 56% had isolated ACL tears, 27% had associated minor tears, and 17% had associated major tears of the lateral meniscus. Univariate analysis revealed significant differences between the three groups for gender (p = 0.002), age groups (p = 0.026), and mechanism of injury (p < 0.001). A contact injury mechanism was a risk factor for minor tears (OR: 4.28) and major tears (OR: 18.49). Additional risk factors for major tears were male gender (OR: 7.38) and age <30 years (OR: 5.85).

Conclusion: Male patients, patients <30 years, and particularly patients who sustained a contact injury have a high risk for an associated major lateral meniscus tear. Special attention is therefore necessary in those patients and early referral to magnetic resonance imaging and/or arthroscopy is recommended to allow meniscus repair in a timely manner.

No MeSH data available.


Related in: MedlinePlus

Lateral meniscus tears defined as major tears. Root tears (defined as avulsion of the meniscus root (A) or complete radial/oblique radial tears within one centimeter from the bony insertion of the lateral meniscus (B)); radial split tears (C) and unstable longitudinal tears including bucket-handle tears (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4389969&req=5

Fig1: Lateral meniscus tears defined as major tears. Root tears (defined as avulsion of the meniscus root (A) or complete radial/oblique radial tears within one centimeter from the bony insertion of the lateral meniscus (B)); radial split tears (C) and unstable longitudinal tears including bucket-handle tears (D).

Mentions: For medicolegal reasons, standardized photographic documentation of every diagnostic arthroscopy and of crucial steps of each arthroscopic procedure is mandatory at our institution, and all photographs are archived in a picture archiving and communication system (PACS). Therefore, digitalized arthroscopic photographs from the index procedure were available for all patients, which were reviewed by a single observer with extensive experience in arthroscopic knee surgery. Based on the arthroscopic appearance of the lateral meniscus, patients were assorted to one of three groups: ‘no tear,’ ‘minor tear,’ and ‘major tear.’ Tear patterns defined as minor were incomplete longitudinal tears or complete stable longitudinal tears not extending further than 1 cm in front of the popliteus tendon and radial or flap tears involving less than 75% of the meniscal width [18-20,23]. Tear patterns defined as major included root tears (defined as avulsion of the meniscus root or complete radial tears within 1 cm from the bony insertion of the lateral meniscus), complete radial tears with transection of the meniscus (‘radial split tears’), and unstable longitudinal tears including bucket-handle tears (Figure 1) [21-24].Figure 1


Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns.

Feucht MJ, Bigdon S, Bode G, Salzmann GM, Dovi-Akue D, Südkamp NP, Niemeyer P - J Orthop Surg Res (2015)

Lateral meniscus tears defined as major tears. Root tears (defined as avulsion of the meniscus root (A) or complete radial/oblique radial tears within one centimeter from the bony insertion of the lateral meniscus (B)); radial split tears (C) and unstable longitudinal tears including bucket-handle tears (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4389969&req=5

Fig1: Lateral meniscus tears defined as major tears. Root tears (defined as avulsion of the meniscus root (A) or complete radial/oblique radial tears within one centimeter from the bony insertion of the lateral meniscus (B)); radial split tears (C) and unstable longitudinal tears including bucket-handle tears (D).
Mentions: For medicolegal reasons, standardized photographic documentation of every diagnostic arthroscopy and of crucial steps of each arthroscopic procedure is mandatory at our institution, and all photographs are archived in a picture archiving and communication system (PACS). Therefore, digitalized arthroscopic photographs from the index procedure were available for all patients, which were reviewed by a single observer with extensive experience in arthroscopic knee surgery. Based on the arthroscopic appearance of the lateral meniscus, patients were assorted to one of three groups: ‘no tear,’ ‘minor tear,’ and ‘major tear.’ Tear patterns defined as minor were incomplete longitudinal tears or complete stable longitudinal tears not extending further than 1 cm in front of the popliteus tendon and radial or flap tears involving less than 75% of the meniscal width [18-20,23]. Tear patterns defined as major included root tears (defined as avulsion of the meniscus root or complete radial tears within 1 cm from the bony insertion of the lateral meniscus), complete radial tears with transection of the meniscus (‘radial split tears’), and unstable longitudinal tears including bucket-handle tears (Figure 1) [21-24].Figure 1

Bottom Line: A database of 268 patients undergoing primary ACL reconstruction was used to identify all patients with isolated ACL tears and patients with an associated tear of the lateral meniscus.Of those, 56% had isolated ACL tears, 27% had associated minor tears, and 17% had associated major tears of the lateral meniscus.Special attention is therefore necessary in those patients and early referral to magnetic resonance imaging and/or arthroscopy is recommended to allow meniscus repair in a timely manner.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany. matthias.feucht@gmx.net.

ABSTRACT

Background: The pattern of lateral meniscus tears observed in anterior cruciate ligament (ACL)-injured subjects varies greatly and determines subsequent management. Certain tear patterns with major biomechanical consequences should be repaired in a timely manner. Knowledge about risk factors for such tears may help to identify patients in the early posttraumatic phase and subsequently may improve clinical results.

Methods: A database of 268 patients undergoing primary ACL reconstruction was used to identify all patients with isolated ACL tears and patients with an associated tear of the lateral meniscus. Patients who underwent surgery >6 months after the injury were excluded. Based on the arthroscopic appearance of the lateral meniscus, patients were assorted to one of three groups: 'no tear,' 'minor tear,' and 'major tear.' Tear patterns defined as major included root tears, complete radial tears, and unstable longitudinal tears including bucket-handle tears. Univariate analysis was performed by comparing the three groups with regard to gender, age, height, weight, BMI, type of injury (high-impact sport, low-impact sport, and not sports related), and mechanism of injury (non-contact vs. contact). Multivariate logistic regression was carried out to identify independent risk factors for minor and major meniscal tears and to calculate odds ratios (OR).

Results: Two hundred fifteen patients met the inclusion and exclusion criteria. Of those, 56% had isolated ACL tears, 27% had associated minor tears, and 17% had associated major tears of the lateral meniscus. Univariate analysis revealed significant differences between the three groups for gender (p = 0.002), age groups (p = 0.026), and mechanism of injury (p < 0.001). A contact injury mechanism was a risk factor for minor tears (OR: 4.28) and major tears (OR: 18.49). Additional risk factors for major tears were male gender (OR: 7.38) and age <30 years (OR: 5.85).

Conclusion: Male patients, patients <30 years, and particularly patients who sustained a contact injury have a high risk for an associated major lateral meniscus tear. Special attention is therefore necessary in those patients and early referral to magnetic resonance imaging and/or arthroscopy is recommended to allow meniscus repair in a timely manner.

No MeSH data available.


Related in: MedlinePlus