Does the timing of ACL reconstruction affects meniscal tear type?: A retrospective cohort study

Anterior cruciate ligament (ACL) injuries are often accompanied by meniscal tears, and the timing of reconstruction may influence tear characteristics. The aim of this study was to evaluate the effect of the timing of ACL reconstruction (ACLR) on meniscal injuries and to examine the association of surgical delay with the incidence, type and repairability of meniscal tears. This retrospective study included patients who underwent ACLR between January 2023 and January 2024. Demographic data, mechanism of injury, time between injury and surgery, and arthroscopic video recordings were obtained from the hospital system. The type of meniscal tears (longitudinal, horizontal, radial, bucket handle, ramp lesion, root tear, complex), tear localization (anterior, middle, posterior) and zonal classification were recorded according to the Cooper system. Statistical analyses were performed to evaluate the incidence of meniscal tears, changes related to surgical timing and repairability rates. A total of 46 patients were included in the study. The mean age of the patients was 30.8 years (17-52) and the mean interval between injury and surgery was 9.4 months (6-18). The meniscal tear rate was 63% and 66% of these tears were observed in the medial meniscus. Bucket-handle tears were the most common tear type and were significantly more common in the medial meniscus (P <.001). Despite this, all meniscal tears were found to be repairable. Our study shows that delayed ACLR increases the frequency of medial meniscal and bucket-handle tears. However, repairability of meniscal tears was preserved despite surgical delay. This finding suggests that surgical timing alone may not be the sole determinant and that tear morphology, surgical technique and patient factors may also play an important role. Further large scale, prospective and randomized controlled studies are needed to determine the optimal timing of ACLR for meniscal preservation.