Predictors of meniscal pathology in paediatric chronic anterior cruciate ligament tears: a case-control study.

Abstract

Long-term outcomes following anterior cruciate ligament (ACL) injury in paediatric populations are unclear, with particular concern for post-traumatic osteoarthritis (PTOA). Meniscal pathology is a key predictor of OA and poorer outcomes, frequently occurring alongside ACL injury. This study aims to quantify the risk factors for concomitant meniscal pathology in children and adolescents ACL injury. Perioperative data from 347 ACL reconstructions with meniscal pathology were extracted from a paediatric ACL registry. Demographic, injury-related, and physical factors, including age, sex, ethnicity, injury characteristics, body mass index (BMI), leg dominance, Beighton's score, knee extension range of motion, anteroposterior laxity, skeletal maturity, and time to surgery, were analyzed. Univariate and multivariate binomial logistic regression evaluated for predictors of meniscal pathology. Meniscal pathology was present in 58.5% of patients: 53.7% lateral meniscus (LM), 26.1% medial meniscus (MM), and 20.2% both. Increasing BMI and Māori and/or Pacific Islander (MPI) ethnicity were individual predictors of meniscal pathology. MPI adolescents were 4.1-fold increased risk for lateral meniscal injury and a 5-fold increased risk for any tear. Increasing BMI was associated with MM tears (OR 1.19) and combined LM/MM tears (OR 1.31). Meniscal pathology is highly prevalent in paediatric ACL injury. Identifying at-risk populations is critical for PTOA prevention and improved long-term outcomes. MPI adolescents with higher BMI may benefit from targeted injury-prevention strategies and counselling on modifiable risk factors.