Annals of the Royal College of Surgeons of England
July 23, 2026 · via Europe PMC
Quantifying the current impact of listing ACL reconstructions as low priority on subsequent meniscal pathology.
Bellamy M, Allan S, Pearce L, Stedman T, Legg A, Anderson A.
AI summary — for doctors, generated from the abstract only
Delays to ACL reconstruction were associated with new meniscal tears, with risk rising about 0.3% per day of waiting.
What was studied
A retrospective cohort of 272 consecutive ACL reconstructions (2018-2024) comparing preoperative MRI and intraoperative meniscal findings by waiting time.
Key findings
- 15.1% had new meniscal tears at surgery absent on initial MRI
- Median time to surgery 140 days
- Each waiting day increased meniscal tear risk by 0.3% after adjustment for sex and BMI
- BMI was significant only after excluding outliers
Clinical relevance
Raises concern about deprioritizing ACL reconstruction; retrospective data cannot fully exclude MRI miss rates.
Who should care
Limitations
Retrospective design; some 'new' tears may reflect MRI sensitivity limits.
Longer waits for ACL surgery were linked to more meniscal tears.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Introduction
Anterior cruciate ligament (ACL) ruptures can cause knee instability, potentially leading to meniscal and chondral injury if left untreated. Recent guidance suggests listing ACL reconstruction as lower priority without meniscal pathology. This study examines the risk of subsequent meniscal tears with delayed surgery.
Methods
We conducted a retrospective cohort study (January 2018-March 2024) of consecutive patients who underwent ACL reconstruction. Patients were categorised by preoperative magnetic resonance imaging (MRI) findings of meniscal tears, and time from listing to surgery. Intraoperative findings of meniscal tears were recorded. Nonparametric testing and binary logistic regression determined risk factors for meniscal pathology with delayed surgery.
Results
Among 272 patients, 15.1% had new meniscal tears identified intraoperatively that were absent on initial MRI scan, with a male-to-female ratio of 3:1. Additionally, 5% had MRI-detected pathology not confirmed surgically. Median time to diagnosis was 21 days, and median time to surgery was 140 days. Age and time to diagnosis did not affect outcomes (p>0.05). Body mass index (BMI) differences were not significant overall but became significant when outliers (BMI>43) were excluded (p=0.038). Logistic regression, adjusting for sex and BMI, showed a 0.3% increase in meniscal tear risk per waiting day (p=0.013).
Conclusions
This study highlights the risk factors and progression of meniscal tears following delayed ACL reconstruction. Patient BMI and waiting list duration are important factors for risk reduction. With a delay of a month to surgery, the likelihood of developing a meniscal tear increases by nearly 10%. These findings emphasise the importance of early intervention, and potential re-evaluation of the current guidance.
DOI
10.1308/rcsann.2026.0054
PMID
42489033
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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