Timing of ACL Reconstruction and Spontaneous Meniscal Healing in Adolescent Patients With Concomitant Injuries.

Abstract

Background: Meniscal injuries frequently accompany acute anterior cruciate ligament (ACL) tears, creating clinical dilemmas regarding optimal surgical timing. While delayed reconstruction increases risks of progressive meniscal damage, early intervention may interrupt natural healing capacity in the adolescent population. This study examines relationships between surgical timing, detailed tear characteristics, and meniscal healing patterns in adolescent ACL injuries.

Methods: A retrospective cohort analysis of 55 adolescent patients (mean age: 14.9±1.9 y, range: 11.9 to 18; 63.6% male) undergoing arthroscopic ACL reconstruction (2015 to 2024) compared preoperative MRI findings with intraoperative meniscal evaluations. Individual meniscal tears (n=64) were characterized by anatomic location and morphologic configuration. Meniscal healing (absence of arthroscopically visible tears previously seen on MRI) was the primary outcome. Secondary analyses examined healing rates by location and surgical timing as a continuous variable. Multivariate logistic regression identified independent predictors.

Results: Among 64 individual tears, 29 (45.3%) demonstrated spontaneous healing. Continuous timing analysis revealed healed tears averaged earlier surgery at 169.8±78.4 days versus persistent tears at 203.4±89.2 days (difference: 33.6 d, P=0.021). Medial meniscal tears showed significantly higher healing rates than lateral tears (60.0% vs. 27.6%, P=0.006). Multivariate analysis identified 3 independent predictors: medial location (OR: 3.9, 95% CI: 1.5-10.1, P=0.005), earlier surgical timing per day (OR: 0.994, 95% CI: 0.989-0.999, P=0.021), and posterior horn location (OR: 2.8, 95% CI: 1.1-7.2, P=0.031). Six new tears were identified at surgery (10.9% rate), with 5 occurring in patients with delayed surgery (>120 d from injury).

Conclusion: This analysis demonstrates significant associations between surgical timing and meniscal healing in adolescent ACL injuries, with each day of delay associated with a 0.6% reduction in healing odds. These preliminary findings require validation in larger prospective studies before influencing treatment decisions but may inform patient counseling regarding expected outcomes.

Level of evidence: Level III-retrospective cohort study.