Delayed anterior cruciate ligament (ACL) reconstruction in skeletally immature patients is associated with increased prevalence and complexity of meniscal tears

BACKGROUND: Anterior cruciate ligament (ACL) injuries in skeletally immature patients are increasingly common. Although timely ACL reconstruction is advocated to restore knee stability and preserve meniscal integrity, the influence of surgical timing on specific meniscal tear patterns remains incompletely understood. METHODS: Consecutive skeletally immature patients who underwent primary ACL reconstruction between June 2022 and June 2025 were included. Meniscal tears were assessed arthroscopically and their prevalence was stratified according to the interval between injury and surgery in 4 groups: <1 month, 1-3 months, 3-6 months and >6 months from injury. RESULTS: Eighty-seven skeletally immature patients (76% males; mean age 14.4 ± 1.7 years) were included. Although the overall prevalence of meniscal tears did not differ according to surgical timing, distinct patterns of medial and lateral meniscal injury were observed. Medial meniscal tears, particularly bucket-handle and longitudinal lesions, increased from 12% in patients treated within 1 month to 75% in those treated after 6 months (p = 0.018). In contrast, partial longitudinal lateral meniscal tears were more common in patients treated within 3 months than after 3 months (17% vs 0%; p = 0.033). CONCLUSION: Delayed ACL reconstruction in skeletally immature patients was associated with a higher prevalence of medial meniscal tears, particularly complex longitudinal and bucket-handle lesions. In contrast, partial longitudinal tears of the lateral meniscus were identified only in patients treated within the first 3 months after injury. These findings suggest that medial and lateral meniscal tears may follow distinct temporal patterns following ACL injury in skeletally immature patients. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level IV. CLINICAL RELEVANCE: Recognition of the association between surgical timing and specific meniscal tear patterns may improve preoperative planning and patient counseling in skeletally immature patients undergoing ACL reconstruction. These findings also support current recommendations favoring timely ACL reconstruction to preserve meniscal integrity in skeletally immature patients.