Prevalence of Meniscal and Articular Surface Injuries in Patients Undergoing Primary and Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Analysis

Background Patients undergoing anterior cruciate ligament reconstruction frequently present with concomitant meniscal or articular cartilage injuries. In revision anterior cruciate ligament reconstruction (ACLR), the prevalence of articular cartilage damage is higher compared to primary reconstruction. However, limited data are available regarding the extent and distribution of cartilage damage by articular surface. Objective To determine the differences in the prevalence and characteristics of meniscal tears and articular surface injuries between patients who underwent primary ACLR or ACLR revision. Methods A cross-sectional study of patients undergoing ACL surgery between 2017 and 2023. Patient characteristics and arthroscopic findings on the location and type of meniscal injury, as well as the degree of chondral lesion, were recorded by the surgeon. A chi-square test was used to determine differences between reconstruction and revision patients, and a simple logit model was used to estimate the risk of lesions. Results Around 527 surgeries were analyzed: 92.79% reconstructions and 7.21% revisions. Meniscal tear prevalence was 69.83% and was more frequent in the lateral menisci. Complex and degenerative tears were more frequent in revision patients. Overall, articular surface chondral damage prevalence was 24.48% and was affected by the meniscal condition and revision status (OR=3.53 (95% CI: 1.72‒7.28)), up to 42.72% and 66.67% in reconstruction and revision patients, respectively. Discussion Lateral and medial meniscus injuries were common, with complex tears more frequent in revisions. Chondral lesions were more often detected when both menisci were torn or when the lateral meniscus alone was affected. The medial femoral condyle emerged as the most commonly injured articular surface. Although conflicting evidence exists regarding meniscal tear incidence in revision cases, degenerative and multidirectional tears appeared to be more prevalent. Future research is needed to clarify injury patterns, improve detection of minor chondral damage, and optimize surgical timing. Conclusion Meniscal tears (up to 69.83%) and articular cartilage injuries (24.48%) are common in patients undergoing primary or revision ACL reconstructions. Revision procedures, sex, age, and meniscal tears increase injury likelihood. The medial femoral condyle is most often affected, while the lateral tibial plateau is least involved.