The Journal of Bone and Joint Surgery (American). 2009;91:2094-2103.
doi:10.2106/JBJS.H.00888
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Geographic Mapping of Meniscus and Cartilage Lesions Associated with Anterior Cruciate Ligament Injuries

James R. Slauterbeck, MD1, Petteri Kousa, MD1, Blake C. Clifton, MD1, Shelly Naud, PhD1, Timothy W. Tourville, MEd, ATC1, Robert J. Johnson, MD1 and Bruce D. Beynnon, PhD1

1 Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, 95 Carrigan Drive, Stafford Hall, Burlington, VT 05405. E-mail address for J.R. Slauterbeck: James.Slauterbeck{at}uvm.edu

Investigation performed at the Department of Orthopaedics and Rehabilitation, University of Vermont College of Medicine, Burlington, Vermont

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from the Academy of Finland and of more than $10,000 from the Orthopaedic Research and Education Foundation (Clinician Scientist Award). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM/DVD (call our subscription department, at 781-449-9780, to order the CD-ROM or DVD).

Background: Detailed descriptions of meniscus and articular cartilage lesions associated with anterior cruciate ligament injury have not been presented in the literature. Our goal was to determine the associations between patient sex, age, and surgical delay and the frequency and location of meniscus and articular cartilage lesions seen at the time of the anterior cruciate ligament reconstruction.

Methods: Data were obtained retrospectively from a database of 1209 consecutive patients undergoing anterior cruciate ligament reconstruction between 1988 and 2002. All knee cartilage, meniscus, and ligament injuries were documented on anatomic maps at the time of surgery, and the data were analyzed.

Results: Meniscus injuries were identified in 722 (65%) of the 1104 patients who met the criteria for inclusion in the study. Female patients were less likely to have a meniscus injury than male patients were (56% compared with 71%), and male patients were more likely to have combined medial and lateral meniscus injuries than female patients were (20% compared with 11%). Patients with a surgical delay of less than three months were less likely to have a medial meniscus injury (8% compared with 19%). Femoral articular cartilage injuries were identified in 472 patients (43%). Patients who were twenty-five years of age or older were more likely to have multiple cartilage lesions throughout the knee (7.7% compared with 1.3%) and to have more isolated medial femoral condyle lesions (24.2% compared with 13.3%). Patients with a surgical delay of more than one year were more likely to have a lesion (60% compared with 47% for all others), and a surgical delay of more than one year resulted in a greater proportion of large and grade-3 lesions of the lateral femoral condyle. Female patients had a greater proportion of grade-1 lesions of the medial femoral condyle (29% compared with 16%), whereas male patients had a greater proportion of grade-3 and 4 lesions of the medial femoral condyle (49% compared with 35%). In patients who were thirty-five years of age or older, meniscus injuries were more frequent and were located more frequently on the medial side; femoral articular cartilage lesions were also located more frequently on the medial side.

Conclusions: Increased age, male sex, and increased surgical delay all increase the frequency and severity of injuries of the meniscus and/or articular cartilage after an anterior cruciate ligament tear.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.


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