Spontaneous healing of meniscal tears with ACL injuries and its impact on timing of ACL surgery

Key Points

1. Meniscus tears occur alongside up to 40% of ACL tears.

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BACKGROUND & OBJECTIVE

There are an estimated 400,000 ACL reconstructions (ACLR) worldwide per year, with this number continuing to grow (1). Meniscal tears occur alongside ACL tears in up to 40.5% of cases (2). Preserving meniscal tissue is an important treatment goal for long term knee health (3). The status of the meniscus post ACLR is a key predictor of post-ACLR degenerative changes and risk of developing osteoarthritis. Although meniscus repair techniques have improved, outcomes remain unsatisfactory. Up to 10% require revision with two years and up to 20% fail within five years (4, 5).

Emerging evidence has demonstrated that the meniscus has the potential to heal itself, suggesting a benefit to delaying surgery and allowing for spontaneous healing. Healing capacity varies substantially by location and type of tear. Lateral meniscus (LM) and longitudinal tears appear to have the best healing capacity due to enhanced vascularity and favorable biomechanical characteristics.

In this paper, the authors sought to characterize meniscus healing trajectories in ACL tears, correlate tear characteristics, and provide a framework for ACLR surgical timing decision making.

The status of the meniscus post ACLR is a key predictor of post-ACLR degenerative changes and risk of developing osteoarthritis.

Patients who have a stable knee, a meniscus tear that fits into a more favorable healing category and are not in a rush to return to sport have more reason to delay their ACLR for up to three months.

METHODS

• 2723 patients (1979 men, 744 women, mean age 29) were utilized in this study over a three-year period from 2020 to 2023.

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