An older age, a longer duration between injury and surgery, and positive pivot shift test results increase the prevalence of articular cartilage injury during ACL reconstruction in all three compartments of the knee in patients with ACL injuries

Abstract

Purpose To investigate factors that inluence the prevalence of articular cartilage injury in patients with anterior cruciate ligament (ACL) injury. Methods This multicentre study included patients with ACL injury. Logistic regression analysis was conducted to identify factors that inluence the prevalence of cartilage injury during ACL reconstruction. Results A total of 811 patients were enrolled. The factors that signiicantly inluenced the prevalence of cartilage injury were age (odds ratio [OR], 1.04; P = 0.000), a positive pivot shift test result (OR, 1.43; P = 0.021), medial meniscal injury (OR, 2.55; P = 0.000), and delayed surgery (≥ 12 months) (OR, 2.52; P = 0.028) in the medial compartment of the knee; age (OR, 1.05; P = 0.000), subjective grades of apprehension during the pivot shift test (OR, 1.46; P = 0.010), lateral meniscal injury (OR, 1.98; P = 0.003), femoro-tibial angle (FTA) (OR, 0.92; P = 0.006), and delayed surgery (≥ 12 months) (OR, 2.63; P = 0.001) in the lateral compartment; and age (OR, 1.06; P = 0.000), body mass index (OR, 1.07; P = 0.028), a positive pivot shift test result (OR, 1.60; P = 0.018), FTA (OR, 0.90; P = 0.006), and delayed surgery (≥ 12 months) (OR, 3.17; P = 0.008) in the patellofemoral compartment. Conclusion An older age, a longer duration between injury and surgery, and a positive pivot shift test result were positively associated with the prevalence of cartilage injury in three compartments in patients with ACL injuries. Early ACL reconstruction is recommended to prevent cartilage injury. Level of Evidence Level III.

Articular Cartilage Damage in the Patellofemoral Compartment at ACL Reconstruction Predicts Poor Postoperative Subjective Outcomes in Patients Age 40 and Older

“…[6][7][8]30,31 Nakamae et al demonstrated that a longer duration between injury and surgery was significantly associated with an increased prevalence of articular cartilage injury in the medial, lateral, and patellofemoral compartments in older-age patients, and recommended early ACL reconstruction. 30 Brambilla et al reported that the risk of cartilage lesions in the medial compartment increased after a 12-month delay in surgery and that the risk of injury in the lateral femoral condyle was significantly higher in patients who underwent surgery more than 60 months after an ACL injury than in those who underwent surgery within 3 months of injury. 6 In the present study, the duration between injury and surgery was longer in patients aged !40 years than that in patients aged 20 years.…”

“…age patients, and recommended early ACL reconstruction. 30 Bramblilla et al reported that the risk of cartilage lesions in the medial compartment increased after a 12-month delay in surgery and that the risk of injury in the lateral femoral condyle was significantly higher in patients who underwent surgery more than 60 months after an ACL injury than in those who underwent surgery within three months of injury. 6…”

Adjustable-loop implants are non-inferior to fixed-loop implants for femoral fixation in anterior cruciate ligament reconstruction

“…However, Choi et al [11] found that FLDs had better stability in pivot shift compared with ALDs, which contradicts the findings of this study. The pivot shift test is important because rotational laxity has been associated with additional surgery required to reduce knee laxity and the development of the early onset of osteoarthritis [19, 32, 52].…”

A larger side-to-side difference in anterior knee laxity increases the prevalence of medial and lateral meniscal injuries in patients with ACL injuries

“…Recent studies have compared acute and delayed ACL reconstruction in terms of meniscal damage [4, 15, 17, 20, 23, 29, 32], articular cartilage injury [4, 17, 20, 26, 32], functional outcomes [15, 35], subjective outcomes [15, 27], and sick leave days [36]. From a clinical perspective, the findings of the present study suggest that delayed surgery for patients with ACL injury will cause damage to the medial meniscus, especially for patients who have greater anterior knee laxity and a higher pivot shift test grade.…”