Meniscal injury in the anterior cruciate-deficient knee. A rationale for clinical decision-making

Meniscal injury is common in acute or chronic anterior cruciate ligament insufficiency. The patterns of meniscal lesions are predictable in the acute and chronically unstable knee. The early incidence of meniscal injury is high and increases with time. Meniscal repair has become increasingly successful. Techniques for anterior cruciate ligament reconstruction have also improved, and with more progressive rehabilitation programmes, this has become a more tolerable procedure for both patients of highly athletic lifestyles and more moderate recreational athletes. The decision-making process for the sports medicine physician requires an overall assessment of many variables. A delicate balance of factors such as age, sex, joint laxity, activity level, individual motivation, social circumstances, associated meniscal, collateral ligament and/or chondral damage may sway the surgeon towards a nonoperative or operative decision. At the present time, a 'cook book' answer to each case presented is not available. As in all of medicine, each patient is an entity that requires an individual evaluation and a specific course of treatment. This review aims to help in this decision-making process. Future prospective studies investigating the many variables mentioned will hopefully objectively delineate guidelines for the choice of the most effective therapeutic regimen.