Treatment of Anterior Cruciate Ligament Injuries with Medial Meniscus Lesions and Risk of Osteoarthritis

Risk Factors for Development of Osteoarthritis

Lesions involving both the anterior cruciate ligament (ACL) and medial meniscus present a significantly higher risk for the development of knee osteoarthritis compared to isolated lesions 1
Partial meniscectomy associated with ACL reconstruction increases the risk of osteoarthritis (OR=1.87; 95% CI: 1.45-2.42) 1
Total medial meniscectomy associated with ACL reconstruction presents an even higher risk (OR=3.14; 95% CI: 2.20-4.48) 1
Chondral lesions associated with ACL reconstruction significantly increase the risk of structural osteoarthritis (OR=2.31; 95% CI: 1.35-3.94) 1

The American Academy of Orthopaedic Surgeons suggests that meniscal repair should be the first option whenever technically possible, as it results in similar clinical outcomes to those with isolated ACL injuries, unlike meniscectomy 1

Reconstruction techniques with single or double bundles can be considered, as they present similar results 2
In young patients (<30 years) with vigorous physical activities, early ACL reconstruction is preferable to provide knee stability and protect the menisci from subsequent injuries 3, 1
When surgery is indicated for acute isolated ACL injury, early reconstruction is preferable, as the risk of additional cartilage and meniscus injuries begins to increase after 3 months 2

For skeletally mature patients, the patellar tendon (BTB) graft may be favored to reduce the risk of graft failure or infection 2
Hamstring tendon grafts may be preferred to reduce the risk of anterior knee pain or kneeling pain 2

Adequate rehabilitation is fundamental, including open and closed kinetic chain exercises for quadriceps strength recovery 1
Functional knee orthoses are not recommended for routine use in patients who received primary isolated ACL reconstruction, as they do not confer clinical benefit 2
Addressing modifiable risk factors for non-traumatic osteoarthritis (such as weight control and quadriceps strengthening) after knee injuries 1

The presence of minor osteoarthritic changes does not influence the decision-making process for treatment 3, 4

Even with successful surgical treatment, patients with ACL and medial meniscus injuries have an increased risk of developing knee osteoarthritis in the long term 1

A ressonância magnética é o padrão-ouro para diagnóstico de lesões meniscais, com sensibilidade de 96% e especificidade de 97% em equipamentos de 3T, de acordo com a American College of Radiology 5
A avaliação por imagem é fundamental para caracterizar o padrão de lesão e planejar o tratamento cirúrgico, de acordo com a American College of Radiology 5

O treinamento de força e controle motor deve ser combinado no protocolo de reabilitação, de acordo com a British Journal of Sports Medicine 6
Quando lesões concomitantes (meniscais, cartilagem) estão presentes, a fase inicial de reabilitação deve ser adaptada de acordo com as instruções do cirurgião, de acordo com a British Journal of Sports Medicine 6
O protocolo de reabilitação completo deve ser baseado em critérios de progressão, considerando o tempo desde a cirurgia como necessário, mas não suficiente para progressão, a menos que combinado com critérios físicos e psicológicos objetivos, de acordo com a British Journal of Sports Medicine 6
Reabilitação supervisionada menos intensiva pode ser uma solução viável para pacientes após reconstrução do LCA que não podem pagar por reabilitação supervisionada ou têm acesso limitado à fisioterapia, de acordo com a British Journal of Sports Medicine 6
A adesão do paciente é um dos maiores desafios durante a reabilitação após reconstrução do LCA, e as expectativas do atleta devem ser discutidas, e a longa jornada de reabilitação deve ser explicada, idealmente antes da cirurgia, de acordo com a British Journal of Sports Medicine 6