Summary

Registered athletes exhibited a higher overall rate of lateral meniscal tears and surgical timing within 30 days was associated with a higher incidence of RAMP lesions, particularly in football players who had a higher rate of acute medial meniscus injuries

Abstract

Background

Anterior cruciate ligament (ACL) rupture is one of the most common knee injuries in sports with devastating repercussions. Despite the complexity of these injuries, only a limited number of studies reported sports-specific mechanisms and associated injuries. Additionally, a comprehensive comparative analysis between registered and non-registered athletes remains largely absent from the discourse.
Purpose/Hypothesis: To investigate ACL concomitant meniscus and cartilage injuries and to compare the distribution of the associated injuries between registered and non-registered athletes. Secondly repeating the analysis according to the surgical timing, with a special focus on football players.
Study Design: Cohort study; Level of evidence, 3.

Methods

A retrospective cohort study of prospectively collected data on all primary ACL reconstructions performed in skeletally mature patients at a specialized sports medicine hospital between 2018 and 2022. The primary outcome was the prevalence of ACL-associated injuries among both registered and non-registered athletes across various sports, including football, basketball, volleyball, handball, and others. Secondary outcomes included the classification of associated injuries by the involved structures, prevalence based on the level of competition, and injury-to-surgery time. For the analysis, patients were categorized into two groups based on the timing of surgery (≤30 days and >30 days post-injury). Categorical variables were compared using the Chi-square test, while continuous variables with normal distribution were analyzed using the Student’s t-test.

Results

A total of 586 patients (mean age 27.2±8.3 years; mean injury-to-surgery time 9.6±26.4 months, 543 males) were included in the final analysis. Among these, 252 patients (43.0%) were registered athletes. The distribution of sports was as follows: football (n=162, 64.3%), (64.3%), handball (n=18, 7.1%), volleyball (n=12, 4.8%), rugby (n=11, 4.4%), basketball (n=11, 4.4%) and others sport (n=38, 15.0%). The overall prevalence of concomitant lesions was: meniscal tears in 55.1% of patients (medial meniscal tear 32.1%, lateral meniscal tear 34.1%, RAMP lesion 11.3% and posterolateral root 4.8%) and cartilage lesions in 15.9% (most commonly at the medial femoral condyle – 10.8%). When comparing registered and non-registered athletes, registered athletes exhibited a higher prevalance of lateral meniscal tears (38.9% vs 30.5% - p= .035). There was a significant difference in the injury-to-surgery time between both groups (registered 2.8±4.3 months, non-registered 14.8±33.9 months – p< .001). Subgroup analysis based on injury-to-surgery time (≤30 days vs. >30 days) demonstrated a higher prevalence of RAMP lesions in the acute setting (19.0% vs 9.1% - p= .002). This finding was also consistent in the the football players subgroup, where a higher incidence of medial meniscal tears was noted in the acute setting (RAMP lesion 21.7% within 30 days vs. 5.4% beyond 30 days – p= .002 ; medial meniscal tear 33.3% within 30 days vs. 17.2% beyond 30 days – p= .018). The prevalence of cartilage lesions was not significantly influenced by either sports activity or the injury-to-surgery time.

Conclusion

Registered athletes exhibited a higher overall rate of lateral meniscal tears, while the non-registered one showed a greater overall rate of medial meniscal tears. Additionally, surgical timing within 30 days was associated with a higher incidence of RAMP lesions, particularly in football players who had a higher rate of acute medial meniscus injuries. These findings underscore the importance of tailored injury management strategies based on athlete type and surgical timing.