Delayed ACL reconstruction increases rates of concomitant procedures and risk of subsequent surgery.

Abstract

To utilise a large cross-sectional database to analyse the effects of time duration between diagnosis of anterior cruciate ligament (ACL) tear and ACL reconstruction (ACLR) on concomitant procedures performed and subsequent surgery within 2years. An analysis from 2015 to 2018 was performed using the Mariner PearlDiver Patient Records Database. Current Procedural Terminology (CPT), and International Classification of Diseases (ICD-10) codes identified patients with a diagnosis of ACL tear who underwent subsequent ACLR. Patients were stratified in biweekly and bimonthly increments based on the time duration between initial diagnosis of ACL tear and surgical treatment. Chi-squared analysis was used to compare categorical variables, and trend analysis was performed with Cochran-Armitage independence testing. Of 11,867 patients who underwent ACLR, 76.1% underwent surgery within 2months of injury diagnosis. Patients aged 10-19 were most likely to undergo surgery within 2months of injury diagnosis (83.5%, P < 0.0001). As duration from injury diagnosis to ACLR increased from < 2months to > 6months, rates of concomitant meniscectomy increased from 9.1% to 20.5% (P < 0.0001). The overall 2-year subsequent surgery rate was 5.3%. The incidence of revision ACLR was highest for patients who underwent surgery > 6months after diagnosis (P < 0.0001), whilst the incidence of ipsilateral lysis of adhesions and manipulation under anaesthesia (MUA) was highest for patients who underwent surgery < 2months after diagnosis (P < 0.0001). ACLR at 6-8weeks after diagnosis demonstrated the lowest risk for concomitant procedures as well as 2-year subsequent surgery. The majority of patients undergo ACL reconstruction within 2months of initial ACL tear diagnosis. Delayed surgery greater than 6months after the diagnosis of an ACL rupture leads to increased need for concomitant meniscectomy as well as higher risk for revision ACLR within 2years, but immediate surgery may increase risk for knee arthrofibrosis. IV.