Sommerfeldt M, Goodine T, Raheem A, Whittaker J, Otto D. Relationship Between Time to ACL Reconstruction and Presence of Adverse Changes in the Knee at the Time of Reconstruction.
Orthop J Sports Med 2018;
6:2325967118813917. [PMID:
30560143 PMCID:
PMC6293370 DOI:
10.1177/2325967118813917]
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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.
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