Age and Time to Surgery Are Associated with Concomitant Meniscal Injuries in Adolescent ACL Tears: A Retrospective Cohort Study

<b>Background</b>: Anterior Cruciate Ligament (ACL) tears are increasingly frequent among adolescents and are often accompanied by meniscal and chondral injuries that may compromise long-term outcomes. While risk factors are well documented in adults, they remain less well defined in younger patients, who present unique anatomical and activity-related characteristics. Understanding these associations is essential for optimizing surgical timing and outcomes in this age group. The purpose of this study was to determine the rate of concomitant intra-articular injuries in adolescents undergoing ACL reconstruction and to identify associated risk factors. <b>Methods</b>: We retrospectively reviewed 186 adolescents (12-18 years) who underwent primary ACL reconstruction using a bone-patellar tendon-bone (BPTB) autograft between 1999 and 2020. Demographic, anthropometric, and intraoperative findings on meniscal and chondral lesions were collected. Multivariable logistic regression models were used to identify factors associated with concomitant injuries. <b>Results</b>: Concomitant intra-articular lesions were found in 108 of 186 patients (58.1%). Meniscal tears were the most common finding, involving the lateral meniscus in 27.4%, the medial meniscus in 18.8%, and both menisci in 11.9%. The posterior horn was the most common tear location, and longitudinal and bucket handle patterns predominated. Older age was associated with any concomitant lesion (<i>p</i> = 0.028), and surgical delay (<i>p</i> = 0.021) was associated with a higher likelihood of medial meniscal tears. Sex and BMI were not significantly associated. <b>Conclusions</b>: Concomitant injuries are common in adolescents undergoing ACL reconstruction. Older age and delayed surgery were associated with a higher likelihood of meniscal damage, emphasizing the need for early diagnosis and timely surgical management as potentially relevant to limiting long-term degenerative changes in young athletes. <b>Level of evidence:</b> Level III, retrospective study.