To investigate the risk factors and their warning effectiveness for meniscus tear secondary to delayed anterior cruciate ligament (ACL) reconstruction.

A retrospective cohort study was conducted to analyze the clinical data of 114 patients (114 knees) with ACL injury, who were admitted to Affiliated Hospital of Nanjing University of Chinese Medicine from December 2018 to December 2023, including 78 males and 36 females, aged 11-50 years [29(21, 35)years]. The patients were divided into tear group (n=46) and non-tear group (n=68) according to whether combined with meniscus tear or not during the surgery. Gender, age, duration of disease, smoking history, Body Mass Index (BMI), cause of injury, mechanism of injury, side of the injury, Beighton score, difference of KT-2000 examination, Tegner activity scale of the knee joint, anterior tibial translation sign, medial posterior tibial slope angle, lateral posterior tibial slope angle, and pivot shift grading of the patients in the two groups were recorded. Correlations between the above-mentioned indicators and occurrence of meniscus tear secondary to delayed ACL reconstruction were assessed. In the meantime, the independent risk factors were determined by univariate and multivariate binary logistic regression analysis. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to evaluate the warning effectiveness of each risk factor for meniscal tear secondary to delayed ACL reconstruction.

Univariate analysis showed correlation of duration of disease, BMI, Tegner activity scale of the knee joint, medial posterior tibial slope angle, lateral posterior tibial slope angle and high-grade pivot shift with occurrence of meniscus tear secondary to delayed ACL reconstruction (P<0.01). The results of multivariate binary logistic regression analysis showed that the duration of disease ≥14.5 weeks (OR=1.20, 95%CI 1.05, 1.38, P<0.01), BMI≥26.9 kg/m² (OR=1.36, 95%CI 1.03, 1.81, P<0.05), Tegner activity scale of the knee joint ≥4 points (OR=2.29, 95%CI 1.18, 4.46, P<0.05), medial posterior tibial slope angle ≥11.2° (OR=2.27, 95%CI 1.06, 4.89, P<0.05) and high-grade pivot shift (OR=0.03, 95%CI 0.01, 0.03, P<0.05) were significantly correlated with occurrence of meniscus tear secondary to delayed ACL reconstruction. Results of ROC curve analysis showed that the medial posterior tibial slope angle (AUC=0.86, 95%CI 0.80, 0.93) and duration of disease (AUC=0.85, 95%CI 0.77, 0.92) had good warning value, BMI (AUC=0.78, 95%CI 0.69, 0.87) and Tegner activity scale of the knee joint (AUC=0.73, 95%CI 0.64, 0.83) had ordinary warning value, and the warning value of high-grade pivot shift (AUC=0.60, 95%CI 0.49, 0.71) was the lowest. The combination of the risk factors revealed superior warning effectiveness for meniscus tear second to delayed ACL reconstruction (AUC=0.97, 95%CI 0.96, 1.00).

The duration of disease ≥14.5 weeks, BMI ≥26.9 kg/m², Tegner score ≥4 points, medial posterior tibial slope angle ≥11.2°and high-grade pivot shift are independent risk factors for meniscus tear secondary to delayed ACL reconstruction. The medial posterior tibial slope angle and duration of disease have good warning value, BMI and Tegner scores have ordinary warning value and high-grade pivot shift has the lowest warning value. The combination of the above risk factors has better warning effectiveness for meniscus tear secondary to delayed ACL reconstruction.

Anterior cruciate ligament; Menisci, tibial; Risk factors