Delayed Posterior Cruciate Ligament Reconstruction, Older Age, and Higher Body Mass Index Are Associated With an Increased Prevalence of Concomitant Cartilage and Meniscal Injuries

PURPOSE: To investigate the association between patient characteristics (age, sex, and body mass index), the timing of posterior cruciate ligament reconstruction (PCLR), and the prevalence of concomitant cartilage and meniscal injuries. METHODS: Patients who underwent primary isolated PCLR between August 2016 and July 2024 were included. The presence of cartilage and meniscal injuries was confirmed via arthroscopic evaluation. The status of cartilage was, meanwhile, graded intraoperatively according to the International Cartilage Repair Society classification. Multivariable logistic regression analyses were performed to identify independent risk factors associated with both any-grade cartilage injuries and specifically high-grade (grades III-IV) cartilage injuries. RESULTS: A total of 1003 patients (787 males and 216 females) with a mean age of 33.18 years who underwent primary PCLR were retrospectively reviewed. Longer time from injury to surgery, particularly exceeding 24 months, was significantly associated with a higher risk of patellofemoral cartilage injury (odds ratio [OR], 1.794; P = .016), lateral compartment cartilage injury (OR, 2.141; P = .016), medial compartment cartilage injury (OR, 3.105; P < .001), and medial meniscal injury (OR, 1.990; P = .041) compared with PCLR performed within 3 months of injury. Additionally, older age significantly increased the prevalence of all cartilage and meniscal injuries (P < .001). Increased body mass index was independently associated with a higher incidence of patellofemoral cartilage injury (P = .006). Subgroup analysis revealed that patients with time from injury to surgery exceeding 24 months reported higher preoperative visual analog scale scores (P = .016). CONCLUSIONS: The incidence of concomitant injuries were 43.87% for patellofemoral cartilage, 10.87% for lateral compartment cartilage, 15.15% for medial compartment cartilage, 8.28% for lateral meniscus, and 10.47% for medial meniscus. Furthermore, delayed PCLR, especially beyond 24 months postinjury, coupled with older age and higher body mass index, were all crucial factors related to a higher prevalence of cartilage and meniscal injuries following grade III PCL injuries. LEVEL OF EVIDENCE: Level III, retrospective cohort study.