Incidence of meniscal tears in skeletally immature patients with anterior cruciate ligament (ACL) rupture: Medial tears are more common in patients closer to skeletal maturity while lateral tears in those with more remaining growth.

Abstract

Purpose: To report the prevalence of meniscal tears observed in patients with open physis and anterior cruciate ligament (ACL) rupture and to examine the relationship between meniscus tears and remaining growth.

Methods: Skeletally immature patients who underwent ACL reconstruction between June 2022 and June 2024 in a single institute were included. Patients were considered skeletally immature if the pre-operative knee magnetic resonance imaging (MRI) revealed an open physis. MRI was used to determine the bone age of the patients, and the patients were divided into two groups as >1-year and <1-year remaining growth. Independent sample t-test was used to compare the continuous variables with normal distribution, while the Mann-Whitney U test was used in the case of non-normal distribution. Fisher exact test to compare dichotomous categorical variables.

Results: A total of 57 skeletally immature patients (77% male), with a mean age of 14.8 ± 1.4 years, underwent ACL reconstruction during the study period. A total of 61 meniscal tears were found in 58 patients, resulting in 84% of patients having at least one meniscus tear. Lateral meniscus (65%) tears were observed most frequently during arthroscopy. Moreover, longitudinal tears (23%) were found to be the most common lateral meniscus pathology and Ramp lesion (35%) was found to be the most common medial meniscus pathology. A significantly higher prevalence of meniscal tears was reported in patients with >1-year of remaining growth (p = 0.0162). While medial meniscus tears are more common (52% vs. 18%; p = 0.0195) in patients with ≤1-year remaining growth, lateral meniscus tears are more common in patients with >1-year remaining growth (88% vs. 55%; p = 0.0179).

Conclusion: Medial meniscus tears were more present in patients close to skeletal maturity while lateral tears were more common in patients with higher remaining growth. Considering the high number of false negatives of meniscal tears in preoperative MRI, high suspicion for specific tears should be used taking into account also the patient's remaining growth.

Level of evidence: Level IV.