Timing of reconstruction of the anterior cruciate ligament in athletes and the incidence of secondary pathology within the knee

Abstract

We reviewed a single-surgeon series of 300 athletic patients who had undergone reconstruction of the anterior cruciate ligament in order to establish the relationship between the timing of the reconstruction and the incidence of meniscal and chondral pathology. The patients were divided into five groups according to the time from their injury to surgery as follows: less than two months, two to six months, six to 12 months, 12 to 18 months and more than 18 months. The presence of meniscal tears was recorded and chondral pathology was scored according to the system of the French Society of Arthroscopy. There was a significantly higher chance of a medial meniscal tear occurring in patients undergoing reconstruction after one year from their injury (odds ratio (7.99, p = 0.004). The odds of having a lateral meniscal tear did not change significantly with an increasing interval to reconstruction. The chance of patients developing degenerative changes was found to be significantly higher in the groups operated on after six months from injury (odds ratio 4.04, p = 0.005). We advocate that patients with deficiency of the anterior cruciate ligament should be counselled that there is a significant relationship between the duration of the instability of their knee and the subsequent incidence of both chondral changes and meniscal tears. In order to minimise these risks, we recommend that reconstruction be performed within the first year from injury.

Posteromedial Meniscal Tears May Be Missed During Anterior Cruciate Ligament Reconstruction

“…Numerous studies have shown higher rates of medial meniscus tears, including ramp lesions, with increased delay before surgery. 3,[31][32][33][34][35] Furthermore, the rate of irreparable medial meniscus tears requiring meniscectomy may also be higher. 36 In our study, patients with PHMM lesions missed at first assessment had a significantly longer interval between injury and surgery.…”

Consequences of Complete ACL Ruptures

“…However, if the injury is treated conservatively, a higher incidence of medial meniscus tears occurs with the passage of time [ 83,114,142,146,154 ] . Smith and Barrett [ 146 ] reported in a study of 575 meniscus tears in ACL-de fi cient knees that the medial menisci tears were frequently peripheral and involved the posterior horn.…”

“…Cipolla et al number of patients suffered medial meniscus tears. Kennedy et al [ 83 ] reported that patients had a signi fi cantly higher chance of sustaining a medial meniscus tear if 1 year had elapsed from their injury (odds ratio 7.99, P = 0.004). In their cohort of 300 athletic patients, a signi fi cantly higher incidence of degenerative changes were found in knees that were >6 months post-injury (odds ratio 4.04, P = 0.005).…”

Timing in hip arthroscopy: does surgical timing change clinical results?

“…Despite this, to our knowledge, the best timing for hip arthroscopy has not yet been defined in the orthopaedic literature. As in the case of knee pathology [2], it appears that a general consensus has been reached by most surgeons that surgery should be deferred until the acute symptoms have resolved and conservative treatment has failed. Our aim was to correlate the results of hip arthroscopic surgery with the duration of a patient's preoperative symptoms.…”