Delayed anterior cruciate ligament (ACL) reconstruction surgery may increase the risk of chondral and meniscal injuries but the time interval between injury and surgery is not fully determined and the effect of ACL-deficiency rotational instability may vary among different zones of knee articular cartilage. Purpose To study chondral injuries in ACL-deficiency patients in different articular zones and various durations between ACL injury and reconstruction.: Case series – prospective observational study. Prospective observational study of 212 cases (197 male and 15 female) with specific age group (16-44 years) having ACL injury and managed by arthroscopic ACL reconstruction, articular cartilage injury rate and severity (based on ICRS classification) was assessed in 5 zones of knee articular cartilage and correlated with different durations between injury and surgery as well as correlation with concomitant meniscal injuries. Medial tibia was the most common zone of chondral injury in ACL-deficiency knee (54.2%) while patella was the least common zone (28.8%), severe chondral injuries rate increased from (3%) in patients who were operated within 6 months to (11.1%) in patients of 6-12 months group and higher with longer duration reaching to (63.6%) when ACLR was delayed more than 4 years from injury. Concomitant meniscal injuries were associated with higher rate of severe chondral injuries (20.4%) than cases without meniscal tear (4%), medial meniscal tears were more common (65%) than lateral tears (23.3%) while both menisci were observed in (11.7%), complex meniscal tear was the most common pattern (33.7%) on medial side. Delaying ACL reconstruction surgery will increase frequency of chondral injuries, severe chondral injuries rate is increased after 6 months in medial side and after 2 years on lateral side, concomitant meniscal injury is associated with higher rate of severe chondral lesions.

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