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