• Arthroscopy and Sports Medicine
• Published: 13 February 2019

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

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

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.

Introduction

The anterior cruciate ligament (ACL) plays an important role in the kinematics of the knee joint. It stabilizes the tibia against anterior translation and internal rotation [67]. Especially young patients are affected by acute ruptures of the ACL which occur mostly during non-contact sports-related situations [45]. As chronic anterior rotatory instability leads to functional impairment of the patient and to the development of osteoarthritis, ACL reconstruction is generally indicated in young and active patients [52]. In Germany, the incidence of ACL reconstruction or repair is 46 per 100,000 persons/year [18].

There is evidence in the literature that the state of the menisci and the cartilage influences outcomes after ACL reconstruction [6, 16, 21]. Claes et al. [15] have shown that the rate of osteoarthritis is significantly higher in patients after ACL reconstruction and partial meniscectomy than in patients with ACL reconstruction alone, which demonstrates that the integrity of the menisci is a key factor in the development of osteoarthritis in the ACL-injured knee.

Biomechanical studies have shown that anterior tibial translation in the chronic ACL-deficient knee leads to stress concentrations on the posterior horns of the menisci [23, 53, 58]. Therefore, chronic anterior rotatory instability is considered a risk factor for the development of secondary meniscus damage after ACL rupture. However, some authors deny this conclusion [27]. In a recently published prospective randomized trial there was no significant difference in the rate of meniscus surgery between patients with acute ACL reconstruction and delayed optional ACL reconstruction [27].

The aim of this article is to perform a systematic literature review and meta-analysis of clinical trials studying the rates of meniscus and cartilage lesions observed at different time points after ACL rupture to determine if the ACL-deficient knee is a risk factor for the development of secondary meniscus and cartilage lesions.

Materials and methods

Search details

We conducted a comprehensive literature search using the PubMed database (U.S. National Library of Medicine) to identify peer-reviewed articles about the rate of secondary meniscus and cartilage lesions with respect to the time since initial injury. This literature search was performed according to the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) [41, 47].

Before the literature search started, an open registration of the intended review was made. The study was registered at PROSPERO, which is an online, free, prospective international systematic review register (http://www.crd.york.ac.uk/PROSPERO; registry number: CRD42017076897).

Inclusion and exclusion criteria

Inclusion criteria to qualify for this systematic review were:

1. 1.Trials reporting the rate of meniscus and/or cartilage lesions at certain time points after ACL rupture,
2. 2.English language reports, and
3. 3.Publication in a peer-reviewed journal.

Exclusion criteria were:

1. 1.Publication dates earlier than the year 2000.
2. 2.Studies reporting exclusively about patients younger than 18 years.
3. 3.Other systematic reviews and meta-analyses.

Search strategy

Different combinations of the following keywords were utilized: anterior cruciate ligament, ACL, cartilage injury, cartilage lesion, chondral injury, chondral lesion, meniscus injury, meniscus lesion, meniscal injury, meniscal lesion. The search was conducted from October 1st till October 20th 2017 in PubMed. After identifying the articles, all references were screened for additional relevant publications. The main search was performed by reviewers JM, WP, and SS.

The publications were judged for inclusion suitability primarily from the abstract. If the abstract showed any inclusion criteria, the entire paper was read. All reviewers affirmed the inclusion of each of the final studies and performed the analysis of the articles. Any publication that did not fulfill all inclusion criteria was rejected. All reviewers had to agree to include or exclude an article. Articles, which have been included in previous systematic reviews and meta-analysis, were not excluded.

If two separate studies had the same authors and intervention but had different follow-up, then only the study with the longer follow-up was included for the outcome analysis. However, for the methodological analysis, duplicate publications, appendices of the included study, and publications of the study design were analyzed.

Study quality and limitations

The quality of the included studies was analyzed by means of the Methodological Index for Non-Randomized Studies (MINORS), which consists of eight items for non-comparative studies and four additional items for comparative studies [60]. A maximum of 2 points can be assigned to each item, resulting in a maximum score of 16 points for non-comparative studies and 24 points for comparative studies. The assessment was performed independently by three reviewers (JM, AO, JB) and the average was taken as the final score.

For the analysis of further limitations, the articles were screened by each of the reviewers. If a possible limitation was found, it was noted. All limitations were discussed among the reviewers. The limitation was accepted, if all reviewers agreed.

Primary and secondary outcome parameters

The primary outcome parameter was the rate of meniscus lesions at different time points after ACL rupture. Secondary outcome parameters were the rate of cartilage lesions and the rate of meniscal repair at different time points after initial ACL injury.

Meta-analysis

The meta-analysis was performed using the R programming language (v3.5.1) and the metafor package (Wolfgang Viechtbauer, v2.0–0) within the RStudio-integrated development environment (v1.1.456). If the absolute numbers and ratios of patients with either meniscal injuries or cartilage injuries at different time points were given, these studies were included in separate meta-analyses. The rates of affected patients before and after the most frequently referred critical time points were compared and the risk ratios (RR) were calculated as effect size. Heterogeneity between the studies was assessed by the DerSimonian-Laird estimator for τ² and represented by the I² value. An I² value of > 50% was considered to indicate substantial heterogeneity. Random-effect models were used to calculate the weighted pooled risk ratios of the included studies and forest plots were created to represent the results. Funnel plots of the included studies were assessed for asymmetry, indicating possible publication bias.

Results

Search results and study design

The search results are shown in Fig. 1. A total of 40 original articles were identified and included in this systematic review. Three articles published results of the same study population with three different follow-ups (1, 2, and 5 years) [25,26,27]. For the outcome analysis, only the report with the 5 years follow-up was included.

Details of the study design are shown in Table 1. Most studies were cohort studies with level III evidence. One trial was a prospective randomized trial with level I evidence [27]. The median MINORS score of the comparative studies was 17/24 (range from 12/24 to 20/24). The number of patients ranged between 31 and 5086. In most studies, the mean age of the patients was in the 3rd decade of life. Except for nine studies, the patient collectives were divided in different comparative groups according to the time from the initial injury to the ACL reconstruction. Regarding the collection of the outcome parameter, only one study referred solely to magnetic resonance imaging (MRI) [66], while all other studies referred to intraoperative findings during ACL reconstruction. In most of the included studies, the acquisition of the outcome parameter was performed at one time point. Only four studies could provide data at two different time points after the initial injury [3, 24, 63, 66]. According to the funnel plots, a publication bias could not be excluded for any of the conducted meta-analyses (Appendix, Figs. 2, 3, 4, 5, 6, 7).Table 1 Study characteristics, study quality, and summary of the main results of the 40 included studiesFull size table

Incidence of meniscal injuries

A total of 38 studies reported about the rate of meniscal injuries. Of these studies the majority of 32 studies (84.2%) showed an association between a longer time after ACL rupture and a higher rate of meniscal injuries. One study did not demonstrate this association, but found that there was a worse chance for meniscal repair with increasing time since the ACL rupture [40]. A minority of five studies did not demonstrate any correlation between time since ACL rupture and meniscal pathologies. A total of 25 studies presented cutoff values regarding the time from injury to ACLR, after which a significant increase in meniscal injuries was detected. Among these 25 studies, 10 studies reported a significant cutoff value at 6 months, while 10 studies reported a significant cutoff value at 12 months. It was possible to include the raw data of 5 and 7 studies, respectively, in separate meta-analyses to compare the rates for any meniscal injury at these two cutoff values. The results are given in Figs. 8 and 9.

Location of meniscal injuries

Among the 32 studies that could show an association between time since injury and the rate of meniscal injuries, 23 studies made a statement about the location of the meniscal injuries. In 20 of these studies (87%), secondary meniscal damage affected only the medial meniscus and not the lateral meniscus, while in the other 3 studies (13%), both the medial and lateral menisci were affected. No study reported about secondary damages that only affected the lateral meniscus.

A total of 21 studies presented cutoff values for the time since ACL rupture, which were associated with a significant increase of medial meniscus injuries. A significant cutoff value at 6 months was stated by 8 studies and a significant cutoff value at 12 months was stated by 7 studies. It was possible to include the raw data of 7 studies each in separate meta-analyses to compare the rates for medial meniscal injuries at these two cutoff values (Figs. 10, 11).

Regarding the incidence of lateral meniscus injuries, seven studies presented cutoff values for the time since ACL rupture, which showed significant differences. While 4 studies reported a higher incidence with a longer time since the ACL rupture [2-month cutoff (n = 1), 12-month cutoff (n = 3)], 3 studies found a higher incidence with shorter time since the ACL rupture [29, 32, 51]. The stated cutoff values were relatively short in 3 of these 3 studies (6 weeks and 8 weeks), while Papastergiou et al. showed a significantly higher rate of lateral meniscal injuries with < 6 months since the ACL rupture [51].

Meniscal repair

A total of seven studies reported the rate of meniscal repair with respect to the time since the ACL rupture. All seven studies found that the rate of meniscal repair significantly decreased as the time from ACL rupture increased. The most common cutoff value that correlated with a lower chance of meniscal repair was 6 weeks (n = 3), followed by 2 months (n = 2), 3 weeks (n = 1) and 6 months (n = 1). Above these cutoff points, the rate of meniscal repair significantly declined.

Cartilage injuries

A total of 34 studies reported on the incidence of cartilage damage with respect to the time since ACL rupture. Of these studies, the majority of 29 studies (85.3%) demonstrated a positive correlation between the rate of cartilage defects in the knee joint and the time since ACL rupture. A total of 22 studies presented cutoff values, which were associated with a significantly higher incidence of cartilage injuries. The most common cutoff value of 12 months was reported by 12 studies, while a cutoff value of 6 months was stated by 5 studies. The raw data of 6 and 9 studies, respectively, were included in separate meta-analyses to compare the rates of cartilage injuries at these two cutoff values (Figs. 12, 13).

Only seven studies presented data about the location of the cartilage defects. As the subdivision of the locations varied widely among these studies, drawing specific conclusions was limited. However, the data showed that the most common site for cartilage defects was the tibiofemoral joint with a balanced distribution between the medial and lateral compartment.

Discussion

A significant majority of the included studies show that chronic instability in ACL rupture leads to secondary meniscal and cartilage damage. Additionally, there is evidence that a longer time since rupture of the ACL is associated with minor chances for meniscal repair.

Only five studies did not report that time from injury was a significant factor for the presence of a meniscal lesion. However, 1 of these studies compared groups ≤ 5 weeks and > 12 weeks from ACL rupture [34] and 1 study compared groups ≤ 6 weeks and > 6 weeks from the ACL rupture [39]. Considering the results of the other included studies, these time frames might be too short to detect a significant difference. A further study which did not detect a significant association was conducted by Ahlen and Liden [1]. They compared a group of 30 patients (Group A), who received ACLR less than 5 months after injury and a group of 31 patients (Group B), who received ACLR more than 24 months after the injury. In Group A, 15 patients (50%) had any meniscal injury and in Group B 20 patients (65%). This difference did not reach statistical significance. However, looking closer at the data and comparing the rate of medial meniscus injuries separately (Group A: 4/30 patients; Group B: 14/31 patients), there was a significantly higher rate in Group B. In the study by Michalitsis et al. [46], which also did not report a significant association between time since ACL rupture and the incidence of meniscal injuries, there was a tendency towards a higher rate of meniscus lesions in the group of late ACL reconstruction after more than 12 months (acute: 22/35 patients, late: 26/35 patients). With more patients (more power), this tendency might become significant. Regarding the deleterious effect of chronic instability, it is important to note that in this study the presence of high-grade cartilage lesions was significantly increased in ACL-deficient knees when reconstruction was performed more than 12 months after injury.

A further study, which could not detect an association between the rate of meniscal injuries and the time since ACL rupture was conducted by Frobell et al. [27]. The authors performed a randomized prospective trial to compare acute ACL reconstruction with delayed optional ACL reconstruction (KANON trial). In the KANON trial, 61 patients were randomized to the group with early ACL reconstruction and 59 patients were randomized to the group with physiotherapy and delayed optional ACL reconstruction. In the group with delayed and optional ACL reconstruction ACL surgery was performed in 29 patients. There was no significant difference in the absolute amount of meniscus surgery between these two treatment groups with 29 in the group with early reconstruction and 32 in the group with initial rehabilitation and optional reconstruction. However, comparison of the two treatment groups with regard to the rate of meniscal surgery solely is misleading since this study did not distinguish between meniscal resection and refixation. Both procedures have different prognoses. In the group with early surgical treatment, almost all meniscal interventions took place in combination with the initial ACL reconstruction. It can therefore be assumed that the proportion of meniscal repair in acute ACL reconstruction is higher than in delayed ACL reconstruction. When the KANON study data are analyzed by the absolute number of meniscal interventions in the treatment groups (including second or third intervention), the results look different. In the group with early ACL reconstruction, a total of 43 meniscal surgeries were performed. In the group with delayed optional ACL reconstruction, 63 meniscal interventions were counted.

The occurrence of secondary meniscus lesions in the ACL-deficient knee can be the result of increased load in the menisci due to increased anterior tibial translation. Several biomechanical studies have shown that the load of the medial and lateral meniscus increases in the ACL-deficient knee [5, 23, 33, 58].

Regarding cartilage lesions, the included studies showed similar results to those of meniscal lesions. Only 5 of the 34 studies which reported on the incidence of cartilage lesions with respect to the time since ACL rupture did not find a significant correlation. Two of these studies compared groups with a relatively short time period after ACL rupture (≤ 3 weeks vs. > 12 weeks [34]; ≤ 6 weeks vs. > 6 weeks [38]), which may be the reason for the absence of a significant difference. The studies by Ahlen and Liden and by Arastu et al. could not detect significant differences between the acute and delayed groups, but there was a trend towards a higher incidence of cartilage lesions in the delayed groups [1, 4]. Considering the relatively small cohorts of 61 and 70 included patients, respectively, these studies might have been underpowered.

In general, the data show that after ACL rupture there is a significant increase in meniscal injuries first before the incidence of cartilage lesions rises, which supports the finding of previous studies that the integrity of the mensici is important for preventing the articular cartilage from early degeneration [15, 40].

Although some authors of the studies which are included in the present systematic review have concluded that early reconstruction preserves the knee from secondary damage, the results of their studies cannot support this conclusion for two reasons. First, because the rate of secondary lesions was in most studies assessed only once at the time of ACLR. Second, because no comparison with a control group without ACLR was performed.

However, Chalmers et al. published a systematic literature review of the long-term results after ACL reconstruction and after non-operative management to answer this research question [11]. Twenty-seven ACL reconstruction cohorts with a total of 1585 patients and 13 non-operative cohorts with a total of 685 patients were included in the review with a mean follow-up of 13.9 years. The results showed that surgical cohorts had significantly less need for subsequent meniscal surgery than non-surgical cohorts (13.9% vs. 29.4%).

The fact that chronic anterior instability leads to secondary meniscus damage and that ACL reconstruction protects the knee from secondary meniscal injury also suggests that ACL reconstruction protects from post-traumatic osteoarthritis. However, this topic is seen as contradictory in the literature. Luc et al. performed a systematic review to determine if ACL reconstruction protects the knee from osteoarthritis [42]. The authors included 38 studies in their analysis. The results showed that the only patients benefiting from ACL reconstruction were those undergoing concomitant meniscectomy. For patients with isolated ACL injury, reconstruction had no protective effect on the development of osteoarthritis. This study further underlines the association of meniscus lesions and instability in the development of osteoarthritis after ACL injury. However, Oiestad et al. showed that most studies that examined osteoarthritis after ACL rupture were of poor quality [50]. One problem with these studies was that they used different radiological scores. As a result, the results of the individual studies are not comparable. For this reason, Ajuied et al. evaluated only studies that have used the Kellgren and Lawrence classification for the analysis of radiographic osteoarthritis [2]. In this systematic review, nine studies with a minimum follow-up of 10 years were included. Six of these studies could be included in a meta-analysis. The results showed that non-surgically treated knee joints had a significantly higher risk of developing radiographic signs of OA (RR, 4.98) than knee joints undergoing ACL reconstruction (RR, 3.62). However, the results also showed that surgically treated knee joints had significantly more often high-grade OA. One possible explanation is that surgery in general may be a risk factor for developing OA changes. Additionally, it must be considered that patients who underwent ACL reconstruction often had the aim to return to sport and were therefore exposed to pivoting and cutting movements more frequently.

Another problem is that long-term results (> 10 years) are needed to evaluate the effect of a surgical procedure on the development of osteoarthritis. This implies that in these studies surgical procedures for ACL replacement were investigated which were used more than 20 years ago. A relevant point is that the transtibial drilling technique was widespread in the early days of athroscopic cruciate ligament surgery. A problem with this drilling technique is that there is a greater risk for a high non-anatomical tunnel misplacement. It can be assumed that the studies analyzed in the previous systematic reviews on posttraumatic osteoarthritis after ACL reconstruction showed a high rate of non-anatomical or partially anatomical femoral and tibial tunnel placements. Biomechanical studies have shown that this tunnel position is not suitable for restoring the rotational stability of the knee joint [8]. Clinical studies have shown that transtibial drilling technique leads to increased laxity and poorer functional scores than the medial portal drilling technique widely used today [56].

The present systematic review has some limitations. One limitation is the quality of the included studies. The majority of studies were of level III evidence according to the Oxford (UK) CEBM levels of evidence. However, this hierarchy of evidence could be questioned, because these guidelines have failed to properly weigh the merits of certain non-randomized controlled trials. One merit of a non-randomized controlled trial is a larger sample of patients and a higher statistical power. The ranking of RCTs near the top of such hierarchies has also been criticized by other authors [10, 52, 64].

A possible publication bias of the studies which were included in the meta-analyses cannot be ruled out, which has to be considered as a further limitation.

Moreover, there is a relevant heterogeneity of the included studies regarding the evaluation of cartilage defects. Different grading systems were used in different studies and some studies did not refer to any grading system. Additionally, some studies considered any kind of cartilage lesion and other studies considered only high-grade cartilage lesions.

Conclusion

The results of this systematic review clearly show that chronic anterior rotatory instability leads to secondary knee injuries with a significant increase of medial meniscus lesions after 6 months followed by a significant increase of cartilage lesions after 12 months. Although there is already evidence of a protective effect of ACL reconstruction in the literature, further studies are needed to confirm these results.

References

1. 1.Ahlen M, Liden M (2011) A comparison of the clinical outcome after anterior cruciate ligament reconstruction using a hamstring tendon autograft with special emphasis on the timing of the reconstruction. Knee Surg Sports Traumatol Arthrosc 19:488–494Article PubMed Google Scholar 
2. 2.Ajuied A, Wong F, Smith C, Norris M, Earnshaw P, Back D, Davies A (2014) Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med 42:2242–2252Article Google Scholar 
3. 3.Anstey DE, Heyworth BE, Price MD, Gill TJ (2012) Effect of timing of ACL reconstruction in surgery and development of meniscal and chondral lesions. Phys Sportsmed 40:36–40Article Google Scholar 
4. 4.Arastu MH, Grange S, Twyman R (2015) Prevalence and consequences of delayed diagnosis of anterior cruciate ligament ruptures. Knee Surg Sports Traumatol Arthrosc 23:1201–1205Article CAS Google Scholar 
5. 5.Atarod M, Frank CB, Shrive NG (2015) Increased meniscal loading after anterior cruciate ligament transection in vivo: a longitudinal study in sheep. Knee 22:11–17Article PubMed Google Scholar 
6. 6.Balasingam S, Sernert N, Magnusson H, Kartus J (2018) Patients with concomitant intra-articular lesions at index surgery deteriorate in their knee injury and osteoarthritis outcome score in the long term more than patients with isolated anterior cruciate ligament rupture: a study from the swedish national anterior cruciate ligament register. Arthroscopy 34:1520–1529Article PubMed Google Scholar 
7. 7.Barenius B, Forssblad M, Engstrom B, Eriksson K (2013) Functional recovery after anterior cruciate ligament reconstruction, a study of health-related quality of life based on the Swedish national knee ligament register. Knee Surg Sports Traumatol Arthrosc 21:914–927Article Google Scholar 
8. 8.Bedi A, Musahl V, Steuber V, Kendoff D, Choi D, Allen AA, Pearle AD, Altchek DW (2011) Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique. Arthroscopy 27:380–390Article Google Scholar 
9. 9.Brambilla L, Pulici L, Carimati G, Quaglia A, Prospero E, Bait C, Morenghi E, Portinaro N, Denti M, Volpi P (2015) 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 43:2966–2973Article Google Scholar 
10. 10.Cartwright N, Munro E (2010) The limitations of randomized controlled trials in predicting effectiveness. J Eval Clin Pract 16:260–266Article PubMed Google Scholar 
11. 11.Chalmers PN, Mall NA, Moric M, Sherman SL, Paletta GP, Cole BJ, Bach BR Jr (2014) Does ACL reconstruction alter natural history?: A systematic literature review of long-term outcomes. J Bone Joint Surg Am 96:292–300Article PubMed Google Scholar 
12. 12.Chen G, Tang X, Li Q, Zheng G, Yang T, Li J (2015) The evaluation of patient-specific factors associated with meniscal and chondral injuries accompanying ACL rupture in young adult patients. Knee Surg Sports Traumatol Arthrosc 23:792–798Article Google Scholar 
13. 13.Chhadia AM, Inacio MC, Maletis GB, Csintalan RP, Davis BR, Funahashi TT (2011) Are meniscus and cartilage injuries related to time to anterior cruciate ligament reconstruction? Am J Sports Med 39:1894–1899Article Google Scholar 
14. 14.Church S, Keating JF (2005) Reconstruction of the anterior cruciate ligament: timing of surgery and the incidence of meniscal tears and degenerative change. J Bone Joint Surg Br 87:1639–1642Article CAS Google Scholar 
15. 15.Claes S, Hermie L, Verdonk R, Bellemans J, Verdonk P (2013) Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis. Knee Surg Sports Traumatol Arthrosc 21:1967–1976Article Google Scholar 
16. 16.Cox CL, Huston LJ, Dunn WR, Reinke EK, Nwosu SK, Parker RD, Wright RW, Kaeding CC, Marx RG, Amendola A, Mccarty EC, Spindler KP (2014) Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study. Am J Sports Med 42:1058–1067Article PubMed PubMed Central Google Scholar 
17. 17.De Campos GC, Nery W Jr, Teixeira PE, Araujo PH, Alves WM Jr (2016) Association between meniscal and chondral lesions and timing of anterior cruciate ligament reconstruction. Orthop J Sports Med 4:2325967116669309. (eCollection 2325967116662016 Oct)Article PubMed PubMed Central Google Scholar 
18. 18.Domnick C, Garcia P, Raschke MJ, Glasbrenner J, Lodde G, Fink C, Herbort M (2017) Trends and incidences of ligament-surgeries and osteotomies of the knee: an analysis of German inpatient records 2005–2013. Arch Orthop Trauma Surg 137:989–995. dArticle Google Scholar 
19. 19.Edwards DJ, Brown JN, Roberts SN, Paterson RS (2000) Long-term results of anterior cruciate ligament reconstruction using ilio-tibial tract and semitendinosis tendon. Knee 7:87–93Article CAS PubMed Google Scholar 
20. 20.Ercin E, Gokhan Bilgili M, Atbasi Z, Tanriverdi B, Hakan Basaran S, Kural C (2015) Importance of restricting sportive activity and time from injury to surgery in anterior cruciate ligament reconstruction. Open Orthop J 9:427–431. https://doi.org/10.2174/1874325001509010427. (eCollection 1874325001509012015)Article PubMed PubMed Central Google Scholar 
21. 21.Filbay SR, Ackerman IN, Dhupelia S, Arden NK, Crossley KM (2018) Quality of life in symptomatic individuals after anterior cruciate ligament reconstruction, with and without radiographic knee osteoarthritis. J Orthop Sports Phys Ther 48:398–408Article PubMed Google Scholar 
22. 22.Fok AW, Yau WP (2013) Delay in ACL reconstruction is associated with more severe and painful meniscal and chondral injuries. Knee Surg Sports Traumatol Arthrosc 21:928–933Article PubMed Google Scholar 
23. 23.Forkel P, Von Deimling C, Lacheta L, Imhoff FB, Foehr P, Willinger L, Dyrna F, Petersen W, Imhoff AB, Burgkart R (2018) Repair of the lateral posterior meniscal root improves stability in an ACL-deficient knee. Knee Surg Sports Traumatol Arthrosc:4949–4948
24. 24.Foster A, Butcher C, Turner PG (2005) Changes in arthroscopic findings in the anterior cruciate ligament deficient knee prior to reconstructive surgery. Knee 12:33–35Article CAS Google Scholar 
25. 25.Frobell RB, Le Graverand MP, Buck R, Roos EM, Roos HP, Tamez-Pena J, Totterman S, Lohmander LS (2009) The acutely ACL injured knee assessed by MRI: changes in joint fluid, bone marrow lesions, and cartilage during the first year. Osteoarthr Cartilage 17:161–167Article CAS Google Scholar 
26. 26.Frobell RB, Roos HP, Roos EM, Hellio Le Graverand MP, Buck R, Tamez-Pena J, Totterman S, Boegard T, Lohmander LS (2008) The acutely ACL injured knee assessed by MRI: are large volume traumatic bone marrow lesions a sign of severe compression injury? Osteoarthr Cartilage 16:829–836Article CAS Google Scholar 
27. 27.Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS (2013) Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ 346:f232. https://doi.org/10.1136/bmj.f1232Article PubMed PubMed Central Google Scholar 
28. 28.Ghodadra N, Mall NA, Karas V, Grumet RC, Kirk S, Mcnickle AG, Garrido CP, Cole BJ, Bach BR Jr (2013) Articular and meniscal pathology associated with primary anterior cruciate ligament reconstruction. J Knee Surg 26:185–193Article Google Scholar 
29. 29.Goradia VK, Grana WA (2001) A comparison of outcomes at 2–6 years after acute and chronic anterior cruciate ligament reconstructions using hamstring tendo
    n grafts. Arthroscopy 17:383–392Article CAS PubMed Google Scholar 
30. 30.Granan LP, Bahr R, Lie SA, Engebretsen L (2009) Timing of anterior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: a cohort study based on the norwegian national knee ligament registry. Am J Sports Med 37:955–961Article Google Scholar 
31. 31.Gupta R, Masih GD, Chander G, Bachhal V (2016) Delay in surgery predisposes to meniscal and chondral injuries in anterior cruciate ligament deficient knees. Indian J Orthop 50:492–498Article PubMed PubMed Central Google Scholar 
32. 32.Hagino T, Ochiai S, Senga S, Yamashita T, Wako M, Ando T, Haro H (2015) Meniscal tears associated with anterior cruciate ligament injury. Arch Orthop Trauma Surg 135:1701–1706Article Google Scholar 
33. 33.Hollis JM, Pearsall AWT, Niciforos PG (2000) Change in meniscal strain with anterior cruciate ligament injury and after reconstruction. Am J Sports Med 28:700–704Article CAS PubMed Google Scholar 
34. 34.Hur CI, Song EK, Kim SK, Lee SH, Seon JK (2017) Early anterior cruciate ligament reconstruction can save meniscus without any complications. Indian J Orthop 51:168–173Article Google Scholar 
35. 35.Jacob KM, Oommen AT (2012) A retrospective analysis of risk factors for meniscal co-morbidities in anterior cruciate ligament injuries. Indian J Orthop 46:566–569Article PubMed PubMed Central Google Scholar 
36. 36.Joseph C, Pathak SS, Aravinda M, Rajan D (2008) Is ACL reconstruction only for athletes? A study of the incidence of meniscal and cartilage injuries in an ACL-deficient athlete and non-athlete population: an Indian experience. Int Orthop 32:57–61Article PubMed Google Scholar 
37. 37.Kennedy J, Jackson MP, O’kelly P, Moran R (2010) Timing of reconstruction of the anterior cruciate ligament in athletes and the incidence of secondary pathology within the knee. J Bone Joint Surg Br 92:362–366Article CAS PubMed Google Scholar 
38. 38.Kluczynski MA, Marzo JM, Bisson LJ (2013) Factors associated with meniscal tears and chondral lesions in patients undergoing anterior cruciate ligament reconstruction: a prospective study. Am J Sports Med 41:2759–2765Article Google Scholar 
39. 39.Kluczynski MA, Marzo JM, Rauh MA, Bernas GA, Bisson LJ (2015) Sex-specific predictors of intra-articular injuries observed during anterior cruciate ligament reconstruction. Orthop J Sports Med 3:2325967115571300Article PubMed PubMed Central Google Scholar 
40. 40.Krutsch W, Zellner J, Baumann F, Pfeifer C, Nerlich M, Angele P (2017) Timing of anterior cruciate ligament reconstruction within the first year after trauma and its influence on treatment of cartilage and meniscus pathology. Knee Surg Sports Traumatol Arthrosc 25:418–425Article Google Scholar 
41. 41.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–e34Article Google Scholar 
42. 42.Luc B, Gribble PA, Pietrosimone BG (2014) Osteoarthritis prevalence following anterior cruciate ligament reconstruction: a systematic review and numbers-needed-to-treat analysis. J Athl Train 49:806–819Article PubMed PubMed Central Google Scholar 
43. 43.Maffulli N, Binfield PM, King JB (2003) Articular cartilage lesions in the symptomatic anterior cruciate ligament-deficient knee. Arthroscopy 19:685–690Article PubMed Google Scholar 
44. 44.Magnussen RA, Pedroza AD, Donaldson CT, Flanigan DC, Kaeding CC (2013) Time from ACL injury to reconstruction and the prevalence of additional intra-articular pathology: is patient age an important factor? Knee Surg Sports Traumatol Arthrosc 21:2029–2034Article PubMed PubMed Central Google Scholar 
45. 45.Mehl J, Diermeier T, Herbst E, Imhoff AB, Stoffels T, Zantop T, Petersen W, Achtnich A (2018) Evidence-based concepts for prevention of knee and ACL injuries. 2017 guidelines of the ligament committee of the German Knee Society (DKG). Arch Orthop Trauma Surg 138:51–61Article PubMed Google Scholar 
46. 46.Michalitsis S, Vlychou M, Malizos KN, Thriskos P, Hantes ME (2015) 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 23:232–239Article Google Scholar 
47. 47.Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012Article Google Scholar 
48. 48.Murrell GA, Maddali S, Horovitz L, Oakley SP, Warren RF (2001) The effects of time course after anterior crucia
    te ligament injury in correlation with meniscal and cartilage loss. Am J Sports Med 29:9–14Article CAS PubMed Google Scholar 
49. 49.O’connor DP, Laughlin MS, Woods GW (2005) Factors related to additional knee injuries after anterior cruciate ligament injury. Arthroscopy 21:431–438Article PubMed Google Scholar 
50. 50.Oiestad BE, Engebretsen L, Storheim K, Risberg MA (2009) Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. Am J Sports Med 37:1434–1443Article Google Scholar 
51. 51.Papastergiou SG, Koukoulias NE, Mikalef P, Ziogas E, Voulgaropoulos H (2007) Meniscal tears in the ACL-deficient knee: correlation between meniscal tears and the timing of ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 15:1438–1444Article Google Scholar 
52. 52.Petersen W (2012) Does ACL reconstruction lead to degenerative joint disease or does it prevent osteoarthritis? How to read science. Arthroscopy 28:448–450Article PubMed Google Scholar 
53. 53.Petrigliano FA, Musahl V, Suero EM, Citak M, Pearle AD (2011) Effect of meniscal loss on knee stability after single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19:S86–S93Article PubMed Google Scholar 
54. 54.Ralles S, Agel J, Obermeier M, Tompkins M (2015) Incidence of Secondary Intra-articular Injuries With Time to Anterior Cruciate Ligament Reconstruction. Am J Sports Med 43:1373–1379Article Google Scholar 
55. 55.Razi M, Salehi S, Dadgostar H, Cherati AS, Moghaddam AB, Tabatabaiand SM, Dodaran MS (2013) Timing of anterior cruciate ligament reconstruction and incidence of meniscal and chondral injury within the knee. Int J Prev Med 4:S98–S103PubMed PubMed Central Google Scholar 
56. 56.Ro KH, Kim HJ, Lee DH (2017) The transportal technique shows better clinical results than the transtibial techniques for single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26(8):2371–2380. https://doi.org/10.1007/s00167-017-4786-1Article PubMed Google Scholar 
57. 57.Rotterud JH, Sivertsen EA, Forssblad M, Engebretsen L, Aroen A (2011) Effect of gender and sports on the risk of full-thickness articular cartilage lesions in anterior cruciate ligament-injured knees: a nationwide cohort study from Sweden and Norway of 15 783 patients. Am J Sports Med 39:1387–1394Article PubMed Google Scholar 
58. 58.Seon JK, Gadikota HR, Kozanek M, Oh LS, Gill TJ, Li G (2009) The effect of anterior cruciate ligament reconstruction on kinematics of the knee with combined anterior cruciate ligament injury and subtotal medial meniscectomy: an in vitro robotic investigation. Arthroscopy 25:123–130Article Google Scholar 
59. 59.Slauterbeck JR, Kousa P, Clifton BC, Naud S, Tourville TW, Johnson RJ, Beynnon BD (2009) Geographic mapping of meniscus and cartilage lesions associated with anterior cruciate ligament injuries. J Bone Joint Surg Am 91:2094–2103Article Google Scholar 
60. 60.Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716Article Google Scholar 
61. 61.Sri-Ram K, Salmon LJ, Pinczewski LA, Roe JP (2013) The incidence of secondary pathology after anterior cruciate ligament rupture in 5086 patients requiring ligament reconstruction. Bone Joint J 95-B:59–64Article CAS PubMed Google Scholar 
62. 62.Tandogan RN, Taser O, Kayaalp A, Taskiran E, Pinar H, Alparslan B, Alturfan A (2004) Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc 12:262–270Article Google Scholar 
63. 63.Tayton E, Verma R, Higgins B, Gosal H (2009) A correlation of time with meniscal tears in anterior cruciate ligament deficiency: stratifying the risk of surgical delay. Knee Surg Sports Traumatol Arthrosc 17:30–34Article PubMed Google Scholar 
64. 64.Worrall J (2002) What evidence in evidence-based medicine? PhiloSci 69:316–330Google Scholar 
65. 65.Yan F, Xie F, Gong X, Wang F, Yang L (2016) Effect of anterior cruciate ligament rupture on secondary damage to menisci and articular cartilage. Knee 23:102–105Article PubMed Google Scholar 
66. 66.Yoo JC, Ahn JH, Lee SH, Yoon YC (2009) Increasing incidence of medial meniscal tears in nonoperatively treated anterior cruciate ligament insufficiency patients documented by serial magnetic resonance imaging studies. Am J Sports Med 37:1478–1483Article Google Scholar 
67. 67.Zantop T, Herbort M, Raschke MJ, Fu FH, Petersen W (2007) The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation. Am J Sports Med 35:223–227Article Google Scholar 

Download references

Funding

There is no funding source.

Author information

Affiliations

1. Abteilung für Sportorthopädie der TU München, Klinikum rechts der Isar der TU, Munich, GermanyJulian Mehl, Joshua B. Baldino, Ralph Akoto & Andreas B. Imhoff
2. Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USAAlexander Otto
3. Chirurgisch-Traumatologisches Zentrum, Asklepios Klinik St.Georg, Hamburg, GermanyAndrea Achtnich
4. Sporthopaedicum, Berlin, GermanySven Scheffler
5. Klinik für Orthopädie und Unfallchirurgie am Martin Luther Krankenhaus, Berlin, Caspar Theysstr. 27-31, 14193, Berlin, GermanyWolf Petersen

Corresponding author

Correspondence to Wolf Petersen.

Ethics declarations

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.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

See Figs. 8, 9, 10, 11, 12 and 13.