Meniscal lesions are more frequent in knees with both ACL and MCL injuries compared to isolated ACL ruptures, especially on the lateral side.
A recent multicentre case-control study by Prof. Cavaignac and his peers titled “Epidemiology and Characteristics of Meniscal Tears in Patients With Combined ACL and Medial Collateral Ligament Injuries Versus Isolated ACL Tears: A Case-Control Study From the Francophone Arthroscopic Society”, provides new insights into the distribution and type of meniscal injuries in patients with ACL tears.
In this prospective French study, 722 patients undergoing ACL reconstruction were included. Two groups were formed: one with isolated ACL tears and the other with combined ACL and MCL injuries. By matching patients on sex, age and BMI, the authors aimed to eliminate any confounding factors. During surgery, senior orthopaedic surgeons systematically examined the knees for various meniscal lesions, including ramp and root tears.
The results were conclusive: meniscal tears occurred in over half (53.2%) of patients with combined ACL-MCL injuries versus 41.4% of those with isolated ACL tears. This significant difference (p = 0.001) highlights the increased risk of associated intra-articular damage when both ligaments are injured.
Even more striking was the prevalence of lateral meniscal lesions, which affected 41.9% of the ACL+MCL group, compared to only 20.8% in the isolated ACL group (p < 0.001). These results held regardless of whether the injury was acute (within 3 months) or chronic. In contrast, medial meniscal lesions were more common in isolated ACL injuries.
Beyond the frequency, the nature of the meniscal tears varied between groups. In patients with ACL+MCL injuries, medial meniscal lesions were predominantly longitudinal (45.9%) and ramp type (28.7%). For patients with isolated ACL ruptures, ramp lesions were far more frequent (58.3%), suggesting a distinct biomechanical context depending on the injury configuration.
No significant differences were found in the type of lateral meniscal lesions, regardless of whether the MCL was involved or not.
These findings underline the importance of thorough intraoperative exploration in ACL injuries, especially when the MCL is also damaged. Understanding the lesion profile helps orthopaedic surgeons better plan reconstruction and rehabilitation.
This large study sheds light on the specific profile of meniscal injuries in combined ACL and MCL lesions. The data clearly show that these combined injuries lead to a higher and different pattern of meniscal damage, particularly on the lateral side.
With over 1000 surgeries per year, Professor Etienne Cavaignac is a leading figure in knee surgery in Europe. His precision and experience make him a trusted expert in complex cases involving multiple ligaments.
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