Relationship Between Time to ACL Reconstruction and Presence of Adverse Changes in the Knee at the Time of Reconstruction

Abstract

Background:Treatment of patients with anterior cruciate ligament (ACL) injuries is often complicated by secondary damage to the meniscus and cartilage.Purpose:To assess the association between time from ACL tear to ACL reconstruction (ACLR) and the presence of intra-articular injuries at the time of ACLR, including meniscal tears, irreparable meniscal tears, chondral damage, and knee compartment degenerative changes.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Consecutive patients undergoing primary ACLR performed by a single surgeon in a Canadian health system over a 5.5-year period were included. Age at ACLR, activity level prior to injury, time from injury to ACLR (TFI), presence and degree of radiographic osteoarthritic features (International Knee Documentation Committee [IKDC] score by tibiofemoral and/or patellofemoral compartment), and surgeon-recorded meniscal lesions (presence and treatment [repair or excision]) and chondral lesions (International Cartilage Repair Society [ICRS] scale grade >2) at time of ACLR were extracted from medical records. The association between TFI (in quartiles: first quartile [0-36 wk] through fourth quartile [110-1000 wk]) and each outcome was assessed with multivariable logistic regression adjusted for age at ACLR and activity level.Results:A total of 860 individual patient records were included. The median patient age was 27.0 years (range, 12-63 years), 47.5% were female (403/849), and 47.2% were classified as playing competitive or professional sports versus recreational sport (337/714). After adjustment for age and activity level, TFI was associated with presence of medial meniscal tear (odds ratio [OR] of fourth-quartile vs first-quartile patients, 3.86; 95% CI, 2.38-6.24; P < .001), medial meniscal tear requiring greater than two-thirds meniscectomy (OR, 5.64; 95% CI, 2.99-10.67; P < .001), medial femoral condyle chondral damage (OR, 3.42; 95% CI, 1.96-5.95; P < .001), and medial tibiofemoral radiographic osteoarthritic features (OR, 22.03; 95% CI, 5.17-93.86; P < .001). TFI was not associated with adverse outcomes in the lateral tibiofemoral or patellofemoral compartments.Conclusion:Increases in TFI are associated with medial meniscal tears, including irreparable medial meniscal tears, medial femoral condyle chondral damage, and early medial tibiofemoral compartment degenerative changes at time of ACLR. These findings highlight the importance of establishing a timely diagnosis and implementing an appropriate treatment plan for patients with ACL injuries. This approach may prevent further instability episodes that place patients at risk of sustaining additional intra-articular injuries in the affected knee. Further research is required to understand the implications of TFI and to determine whether decreasing the TFI alters the natural history after an ACL injury.

Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group

“…With regard to the prevalence of meniscus tears, medial, lateral, and combined lesions were found more often with increasing time from injury (TFI) to surgery (medial meniscus tear prevalence at 0–36-week TFI was 48.2% and when > 61 weeks was 59.3%). Not only did the prevalence of injury increase with time, the rate of meniscectomy also increased (medial meniscectomy at 0–36-week TFI was 7.5%, and when TFI was > 61 weeks, it was 12.8%) [ 76 ]…”

The Role of Patient Characteristics in the Success of Nonoperative Treatment of Anterior Cruciate Ligament Injuries

“…A potential explanation for the small observed difference is that these studies were performed in 2010, whereas nowadays the threshold for indicating patients for ACL reconstruction may be lower than 9 years ago, with more recent studies suggesting that earlier reconstruction prevents meniscal damage. 13,24…”

“…Treating patients with ACL injury nonoperatively prolongs the delay between injury and surgery, which increases the risk of additional meniscal and cartilage damage. 1,8,14,24 Furthermore, treating patients nonoperatively who are participating in higher-impact sports has been shown to result in low return to preinjury level of sports (33%). 16 Treating these patients nonoperatively also increases the time from injury to return to sports, as their time from injury to surgery increases, and increases the indirect costs by requiring longer sick leave time.…”

Treatment After Anterior Cruciate Ligament Injury: Panther Symposium ACL Treatment Consensus Group

“…Not only did the prevalence of injury increase with time, the rate of meniscectomy also increased (with TFI of 0-36 weeks, medial meniscectomy rate was 7.5%, and with TFI of >61 weeks, it was 12.8%). 73 CONCLUSION. Delayed ACL reconstruction in active patients may be a treatment option, but the provider, as well as the patient, must be aware of the risk of secondary injuries with worse long-term outcomes.…”