From the Guidelines
I strongly recommend immediate orthopedic consultation for surgical evaluation of your full thickness ACL tear and extensive medial and lateral meniscus tears, as the most recent and highest quality study suggests that ACL reconstruction is preferred over repair due to lower risk of revision surgery 1. This combination of injuries represents significant knee damage that typically requires surgical intervention, particularly arthroscopic surgery. Before surgery, you should follow RICE protocol:
- Rest the knee
- Apply Ice for 20 minutes every 2-3 hours
- Use Compression with an elastic bandage
- Elevate the leg above heart level when possible. For pain management, take over-the-counter medications like ibuprofen (400-600mg every 6-8 hours with food) or acetaminophen (500-1000mg every 6 hours) until you see a specialist. Use crutches to avoid weight-bearing on the affected knee. Physical therapy will be essential both pre-operatively to maintain muscle strength and post-operatively for rehabilitation. This combination of injuries affects knee stability in multiple planes - the ACL provides front-to-back stability while the menisci provide cushioning and rotational stability. Without proper treatment, you risk chronic instability, accelerated arthritis, and further joint damage, especially if you're physically active or participate in sports involving pivoting movements. Early reconstruction is preferred because the risk of additional cartilage and meniscal injury starts to increase within 3 months 1. It's also important to note that cartilage injury at ACL reconstruction and partial or medial meniscectomy may increase the odds of osteoarthritis 1. Therefore, prompt surgical intervention with ACL reconstruction is crucial to minimize the risk of further complications and improve quality of life.
From the Research
Full Thickness ACL Tear and Extensive Tears of Medial and Lateral Meniscus
- A full thickness ACL tear can lead to extensive tears of the medial and lateral meniscus, with studies showing that the incidence of meniscal tears is higher in chronic ACL cases 2.
- The location of meniscal tears can vary, with lateral meniscal tears being more common in acute ACL injuries and medial meniscal tears being more common in chronic ACL injuries 2.
- Bucket handle tears are also more common in chronic ACL cases, with a higher incidence of medial bucket handle tears 2.
Treatment Options
- Treatment options for full thickness ACL tears and extensive meniscal tears include ACL reconstruction with or without meniscal repair or resection 3, 4, 5, 6.
- Studies have shown that meniscal repair can provide better clinical outcomes than meniscectomy, especially when performed concurrently with ACL reconstruction 4, 5.
- However, the decision to repair or resect the meniscus depends on the location and severity of the tear, as well as the patient's overall condition and activity level 3, 6.
Clinical Outcomes
- Clinical outcomes for patients with full thickness ACL tears and extensive meniscal tears can vary depending on the treatment approach 3, 4, 5, 6.
- Studies have shown that patients who undergo ACL reconstruction with meniscal repair can achieve similar clinical outcomes to those who undergo isolated ACL reconstruction 4, 6.
- However, meniscectomy can lead to worse clinical outcomes, including increased risk of osteoarthritis and total knee arthroplasty 3, 4.