The Long-term Radiographic Fate of the Chronically ACL-Deficient Knee: Response

Authors’ Response:

We thank the authors for their thoughtful comments and agree that meniscal status is a critical determinant of long-term outcomes in the anterior cruciate ligament (ACL)–injured knee. As highlighted, our findings—and the broader literature—consistently demonstrate that meniscectomy is strongly associated with accelerated osteoarthritis, underscoring the importance of meniscal preservation as a key principle in both operative and nonoperative management. ³ Importantly, ACL deficiency itself is associated with an increased risk of secondary meniscal injury over time, likely due to persistent instability and altered knee kinematics, ¹ with prior studies demonstrating higher rates of meniscal tears in chronically ACL-deficient knees. ⁴

This concept is further supported by advanced imaging data; in our recent systematic review, chronic ACL deficiency was associated with a high prevalence of meniscal pathology, cartilage damage, and progressive tibial subluxation on magnetic resonance imaging. ² Taken together, these findings reinforce that long-term joint health after ACL injury is multifactorial and that strategies aimed at early stabilization and, critically, preservation of meniscal integrity may be central to mitigating degenerative progression.