Incidence and Arthroscopic Patterns of Meniscal Injuries Associated with Anterior Cruciate Ligament Tears: A Prospective Observational Study of 30 Patients

Abstract

Background: Meniscal injury is a frequent comorbidity in anterior cruciate ligament (ACL) tears and strongly influences stability, repairability, and long-term osteoarthritis risk. Reported prevalence and tear patterns vary by chronicity, mechanism, and diagnostic intensity. This study quantified the incidence and arthroscopic patterns of meniscal injuries in ACL-deficient knees and explored associations with time-from-injury and patient factors.

Methods: A prospective observational study was conducted on 30 consecutive patients with MRI-confirmed ACL tear undergoing arthroscopic ACL reconstruction at a tertiary centre (January–December 2025). Meniscal status was defined intraoperatively (gold standard) using standardized mapping of side (medial/lateral/both), location (anterior horn/body/posterior horn/root), and morphology (longitudinal, radial/oblique radial, bucket-handle, complex, root tear, ramp lesion). Patients were categorized as acute (<6 weeks) or delayed (≥6 weeks) from injury to surgery. Descriptive statistics were reported; associations were tested using Fisher’s exact test and independent-samples t-test, with α=0.05.

Results: Mean age was 26.7±6.1 years; 73.3% were male. Overall, 18/30 (60.0%) had meniscal injury: medial only 10 (33.3%), lateral only 5 (16.7%), both 3 (10.0%). The posterior horn was the commonest site (medial 72% of medial tears; lateral 67% of lateral tears). Delayed presentation showed higher medial meniscal injury than acute (50.0% vs 14.3%, p=0.040). Acute cases showed a trend toward higher lateral tears (28.6% vs 6.3%, p=0.082). Ramp-type lesions constituted 4/13 (30.8%) of medial injuries, consistent with under-recognized posteromedial pathology described in the literature.

Conclusion: In this 30-patient cohort, meniscal injury accompanied ACL tears in 60%, with a posterior-horn predominance. Delay to reconstruction was associated with a significantly higher rate of medial meniscal injury, supporting early stabilization strategies to reduce secondary medial damage.