# Surgical Delay Beyond Three Months for Primary Anterior Cruciate Ligament Reconstruction Does not Increase Risk of Medial Meniscal Ramp Lesions or Lateral Root Tears

## TL;DR

This study finds that delaying anterior cruciate ligament surgery beyond three months does not increase the risk of certain meniscal tears.

## Contribution

The study shows surgical delay beyond three months does not increase medial meniscal ramp lesions or lateral root tears.

## Key findings

- Medial meniscal tears increase with longer surgical delays, but lateral tears remain unchanged.
- Ramp lesions and lateral root tears are not more common with delayed surgery.
- Soccer and basketball are the primary causes of ACL injuries in this patient group.

## Abstract

To report the percentages of full-thickness meniscal tears per anterior cruciate ligament reconstruction (ACLR) at the time of primary ACLR and the contributions of individual tear patterns, specifically ramp lesions and root tears, to the overall prevalence of tears.

This retrospective cross-sectional study included patients from 2007 to 2021. The inclusion criteria were patients who underwent primary ACLR. Patients were excluded if they had suffered from multiligamentous injuries, were skeletally immature, or had missing information regarding the outcomes. The outcomes included the presence of full-thickness meniscal tears detected during arthroscopy, the tear pattern according to the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine classification, and the time between injury and ACLR. Follow-up data were not collected.

Among 731 patients, 606 were male, and 125 were female. The mean age was 28 ± 8 years, with an average time between injury and surgery of 539 ± 988 days. The primary causes of injury were soccer (38%) and basketball (32%). Medial meniscal (MM) tears occurred in 43.7% knees, while lateral meniscal (LM) tears occurred in 47.5% of patients. Ramp lesions accounted for 46.9% of all MM tears, and root tears accounted for 15.8% of all LM tears. As the time from injury to ACLR increased, MM tears significantly increased (P < .001). However, the time between injury and ACLR was not able to discriminate between the presence or absence of lateral meniscus tears (P = 0.84), ramp lesions (P = .06), or root tears (P = .16).

Aside from the initial 3 months postinjury, the percentage of medial meniscal tears per ACLR steadily increases with increasing time elapsed from injury to surgery, whereas the percentage of lateral meniscal tears per ACLR remains unchanged. Increased surgical delay is not associated with a higher chance of ramp lesions or lateral meniscus root tears observed at the time of primary ACLR.

Level III: Retrospective cross-sectional study.