Demographic Factors Associated With an Increased Incidence of Intra-articular Injuries After Delayed Anterior Cruciate Ligament Reconstruction

Abstract

Background: Delays from the time of an anterior cruciate ligament (ACL) tear to surgical reconstruction are associated with an increased incidence of meniscal and chondral injuries. Purpose: To evaluate the association between delays in ACL reconstruction (ACLR) and risk factors for intra-articular injuries across 8 patient demographic subsets. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We performed a retrospective chart review of all patients who underwent ACLR from January 2009 to May 2015 at a single institution. Variables collected were age, sex, body mass index, time from injury to surgery, and presence of meniscal tears and chondral injuries. Demographic subsets were created according to sex, age (<27 vs ≥27 years), body mass index (<25 vs ≥25 kg/m2), and injury setting (sports vs non–sports related). Subsets were divided by time from injury to ACLR: 0 to <6 months (control group), 6 to <12 months, and ≥12 months. Multivariate logistic regression–generated odds ratios (ORs) were calculated. Results: Overall, 410 patients were included. ORs were significant for an increased incidence of medial meniscal tears (MMTs) (OR, 1.12-3.72; P = .02), medial femoral condyle (MFC) injuries (OR, 1.18-4.81; P = .02), and medial tibial plateau (MTP) injuries (OR, 1.33-31.07; P = .02) with surgical delays of 6 to <12 months. With ≥12-month delays, significance was found for MMTs (OR, 2.92-8.64; P < .001), MFC injuries (OR, 1.86-5.88; P < .001), MTP injuries (OR, 1.37-21.22; P = .02), lateral femoral condyle injuries (OR, 2.41-14.94; P < .001), and lateral tibial plateau injuries (OR, 1.15-5.27; P = .02). In the subset analysis, differences in the timing, location, rate, and pattern of chondral and meniscal injuries became evident. Female patients and patients with non–sports-related ACL tears had less risk of associated injuries with delayed surgery, while other demographic groups showed an increased injury risk. Conclusion: When analyzing patients who were symptomatic enough to eventually require surgery, an increased incidence of MMTs and medial chondral injuries was associated with ≥6-month delays in ACLR, and an increased incidence of lateral chondral injuries was associated with ≥12-month delays. Female patients and patients with non–sports-related ACL tears had less risk of injuries with delayed ACLR.

Incidence and type of meniscal tears in multilligament injured knees

“…Nevertheless, the impact of timing of surgery on meniscus damage in the isolated ACL reconstruction is well known in the literature. Many studies report a higher risk of overall meniscus tear, especially of the medial meniscus in delayed surgery compared to early surgery [6,8,10,[43][44][45][46]. The literature has widely demonstrated in long-term the superiority of meniscus repair in terms of function, return to sports and also cartilage protection, even more since high-energy knee injury increase the long-term risk of post-traumatic osteoarthritis [27,35,47,48].…”

Is Delayed Anterior Cruciate Ligament Reconstruction Associated With a Risk of New Meniscal Tears? Reevaluating a Longstanding Paradigm

“…Among adults, we did not detect greater risk of new medial or lateral meniscal tears after delayed ACL reconstruction, despite the larger sample size. Stone et al 39 similarly reported that ACL reconstruction between 90 days and 1 year after injury in adults aged 40 years was not || References 3,12,15,[17][18][19]21,24,26,27,28,29,32,34,39,43.…”