Delaying anterior cruciate ligament reconstruction increases the rate and severity of medial chondral injuries

Abstract

AimsThe aim of this study was to evaluate the association between chondral injury and interval from anterior cruciate ligament (ACL) tear to surgical reconstruction (ACLr).MethodsBetween January 2012 and January 2022, 1,840 consecutive ACLrs were performed and included in a single-centre retrospective cohort. Exclusion criteria were partial tears, multiligament knee injuries, prior ipsilateral knee surgery, concomitant unicompartmental knee arthroplasty or high tibial osteotomy, ACL agenesis, and unknown date of tear. A total of 1,317 patients were included in the final analysis, with a median age of 29 years (interquartile range (IQR) 23 to 38). The median preoperative Tegner Activity Score (TAS) was 6 (IQR 6 to 7). Patients were categorized into four groups according to the delay to ACLr: < three months (427; 32%), three to six months (388; 29%), > six to 12 months (248; 19%), and > 12 months (254; 19%). Chondral injury was assessed during arthroscopy using the International Cartilage Regeneration and Joint Preservation Society classification, and its association with delay to ACLr was analyzed using multivariable analysis.ResultsIn the medial compartment, delaying ACLr for more than 12 months was associated with an increased rate (odds ratio (OR) 1.93 (95% confidence interval (CI) 1.27 to 2.95); p = 0.002) and severity (OR 1.23 (95% CI 1.08 to 1.40); p = 0.002) of chondral injuries, compared with < three months, with no association in patients aged > 50 years old. No association was found for shorter delays, but the overall dose-effect analysis was significant for the rate (p = 0.015) and severity (p = 0.026) of medial chondral injuries. Increased TAS was associated with a significantly reduced rate (OR 0.88 (95% CI 0.78 to 0.99); p = 0.036) and severity (OR 0.96 (95% CI 0.92 to 0.99); p = 0.017) of medial chondral injuries. In the lateral compartment, no association was found between delay and chondral injuries.ConclusionDelay was associated with an increased rate and severity of medial chondral injuries in a dose-effect fashion, in particular for delays > 12 months. Younger patients seem to be at higher risk of chondral injury when delaying surgery. The timing of ACLr should be optimally reduced in this population.Cite this article: Bone Joint J 2023;105-B(9):953–960.

Adenosine, lidocaine, and magnesium therapy augments joint tissue healing following experimental anterior cruciate ligament rupture and reconstruction

“…ACL injury and its surgical reconstruction is known to increase inflammatory cytokines in the synovial fluid and cartilage breakdown biomarkers which, if not resolved in a timely manner, can lead to poor outcomes. 1 , 2 , 8 , 9 , 48 , 49 Despite sex-specific phenotypic and temporal differences in joint tissue healing profiles, we have shown that perioperative ALM therapy facilitates timely resolution of postoperative inflammation, leading to augmented joint tissue healing profiles in both males and females, 28 days after ACLR surgery. Local infiltration analgesia, commonly comprising lidocaine, is a safe and effective technique widely used by orthopaedic surgeons during ACLR surgery to minimize postoperative pain.…”

Incidence of and Risk Factors for Medial Meniscal Lesions at the Time of ACL Reconstruction: An Analysis of 4697 Knees From the SANTI Study Group Database

“…In the current study, the incidence of MMLs increased in a time-dependent manner: 59.6% of patients with an injury to surgery time >12 months had an MML, compared with 38.7% of patients with an injury to surgery time of 3 to 12 months and only 33.1% with an injury to surgery time <3 months. Multiple previous studies, 1,5-8,16,19,24,34,42,43 with timelines ranging from 3 months to >5 years, have explored the association between concomitant intra-articular lesions and time between injury and ACLR, showing similar trends of increased incidence of MMLs. Tandogan et al 43 reported an odds ratio (OR) for MMLs of 2.2 with a time between index injury and surgery of 2 to 5 years and an OR of 5.9 with an interval >5 years.…”

“…Similar results were also reported by Dumont et al, 11 showing a strong correlation between meniscal lesions and the occurrence of chondral injury to the same compartment, especially at the medial femoral condyle. Moreover, numerous authors 5-7,16,42 have reported an association between increased injury to surgery time and chondral damage. Similarly, our results showed an increased incidence of chondral damage over time (6.1% and 15.6% with an injury to surgery time of <3 months and >12 months, respectively).…”

“…This includes load distribution, shock absorption, articular cartilage protection, proprioception, stabilization of the joint, and joint lubrication. 14 The medial meniscus transmits 50% of the joint load, 6,35,37,38 increases the congruity between knee articular surfaces, and contributes to overall knee joint stability because of the ''brake stop mechanism'' of the posterior horn of the medial meniscus. 23 Loss of function disrupts knee kinematics, resulting in higher loads in the corresponding tibiofemoral compartment, and leads almost inevitably to secondary osteoarthritis in the long term, especially in case of associated chronic anterior instability.…”

Anterior cruciate ligament injuries in female athletes: risk factors and strategies for prevention

“… 3 - 6 In addition to the early physical and psychological morbidity, these injuries are also associated with increased risk of developing knee osteoarthritis in later life. 1 , 7 , 8 As the large majority of ACL injuries are sustained from a noncontact pivot injury, identifying risk factors and developing appropriate preventative strategies may help to reduce the burden of these injuries on the patient, sporting institution and healthcare system.…”