Anterior Cruciate Ligament Tears: The Impact of Increased Time From Injury to Surgery on Intra-articular Lesions

Abstract

Background: Previous research has shown that meniscal and articular cartilage lesions increase with time in the anterior cruciate ligament (ACL)–deficient knee. Purpose: To analyze the association between increased time from ACL injury to reconstruction and the presence of intra-articular lesions. Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective chart review was performed for patients who sustained an ACL injury and underwent reconstruction from January 1, 2009, to May 14, 2015. Factors analyzed included age, sex, and body mass index, as well as time from injury to surgery, the presence of meniscal tears, and the presence of cartilage lesions. The data were evaluated to quantify the association between time from ACL injury to reconstruction and presence of intra-articular lesions. Results: Overall, 405 patients were included in this study. Regarding time from injury, 27.3% patients were treated at <3 months, 23.6% at 3 to <6 months, 18% at 6 to <12 months, 13.6% at 12 to <24 months, 10.6% at 24 to <60 months, and 6.9% at ≥60 months. When compared with the group treated <3 months from injury, a significant increase in the rate of medial meniscal tears was seen in the groups treated at 6 to <12 months (odds ratio [OR], 2.2), 12 to <24 months (OR, 3.5), 24 to <60 months (OR, 7.0), and ≥60 months (OR, 6.3). A similar trend was seen with medial femoral condyle lesions in the groups treated at 6 to <12 months (OR, 2.5), 12 to <24 months (OR, 2.6), 24 to <60 months (OR, 2.6), and ≥60 months (OR, 6.9). The prevalence of lateral tibial plateau and lateral femoral condyle lesions also significantly increased with increased time between ACL injury and reconstruction, but this association was not seen until 24 to <60 months (ORs, 5.1 and 11.5, respectively). Conclusion: For patients undergoing ACL reconstruction, an interval >6 months between injury and surgery was associated with an increased prevalence of medial meniscal tears and medial compartment chondral lesions at the time of surgery. An interval >24 months between injury and surgery was associated with an increased prevalence of lateral compartment chondral lesions at the time of surgery.

Medial meniscus tears are most prevalent in type I ACL tears, while type I ACL tears only account for 8% of all ACL tears

“…ACL tears usually accompany meniscus injuries, but no studies have researched the different types of ACL tears that may influence the prevalence of meniscus tears or different meniscus tear types. In this study, the total prevalence of a meniscus tear with an ACL tear was 56.0%, similar to that in existing research, which has been reported to be 51.9–73.0% [10, 11, 15, 34, 38]. The prevalence [15/22 (68.2%)] of a medial meniscus tear with type I injury was higher than that of other types.…”

Early ACLR and Risk and Timing of Secondary Meniscal Injury Compared With Delayed ACLR or Nonoperative Treatment: A Time-to-Event Analysis Using Machine Learning

“…We identified an almost 25% decrease in probability of meniscal survivorship with an increase in the time to receive surgical intervention beyond 100 days, confirming the findings of extensive previous investigations. 7,22,42 Everhart et al 12 specifically identified delay in ACLR of 8 weeks as the threshold beyond which the risk for a secondary medial meniscal tear identified at time of surgery became significant; similarly, we observed that time to surgery between 50 and 60 days corresponded to the global minima in meniscal survivorship. Interestingly, one modifiable predictor identified in the ACLR model was the use of an expansion device for tibial fixation; although a prospective evaluation noted no clinical differences between methods of fixation for soft tissue grafts at short-term follow-up, 18 this finding may prompt surgeon discretion when choosing this alternative compared with direct compression and suspensory fixation.…”

The Epidemiology of Meniscus Injury

“…In regards to time to ACL reconstruction and associated meniscus tear, a retrospective analysis of West Point cadets undergoing ACL reconstruction showed a 39% incidence of associated meniscus tears and no difference in tear repairability in patients undergoing acute reconstruction (within 30 d) or later reconstruction 54. This is in contrast to studies in the pediatric population that show a significantly higher rate of medial meniscus tears if ACL reconstruction is delayed between 3 and 6 months 35,55,56…”

“…54 This is in contrast to studies in the pediatric population that show a significantly higher rate of medial meniscus tears if ACL reconstruction is delayed between 3 and 6 months. 35,55,56…”