Timing of anterior cruciate ligament reconstruction within the first year after trauma and its influence on treatment of cartilage and meniscus pathology.

Abstract

Anterior cruciate ligament (ACL) ruptures are often associated with primary meniscal and cartilage lesions. Late reconstruction of ACL-deficient knees may increase the risk of developing secondary meniscal and cartilage lesions; hence, the timing of ACL repair is of the utmost importance. Because meniscus outcome is also a potential predictor for osteoarthritis (OA), this study compared ACL repair within the first 6months after injury to that of surgery conducted 7-12months after injury with regard to the incidence of meniscal and cartilage lesions. This prospective cross-sectional study included all complete isolated primary ACL ruptures treated in our institution within 1year after trauma over a 12-month period. Exclusion criteria were revision ACL, complex ligament injuries, previous knee surgery, and missing injury data. Cartilage lesions were classified according to the score established by the International Cartilage Repair Society (ICRS score) and meniscal tears according to their treatment options. Two hundred and thirty-three of 730 patients (162 men, 71 women) with ACL repair met the inclusion criteria. 86.3% of surgical interventions were conducted within 6months and 13.7% after 6months of trauma. Severe cartilage lesions grade III-IV did not significantly differ between the different time points of ACL repair (<6months 39.9%; >6months 31.3%; p=n.s.). Medial meniscus lesions received significantly higher meniscal repair in early compared to delayed ACL repair. Significantly higher rate of meniscal repair of the medial meniscus was seen in cases of early ACL repair compared to delayed (<6months 77.2%, >6months 46.7; p=0.022). The rate of medial meniscal repair in early ACL repair was significantly higher for women (89.5-0%; p=0.002), however, not for men (73.3-53.8%; p=n.s.). No differences were found for lateral meniscal lesions, with regard to neither the different time points (p=n.s.) nor the sex (p=n.s.). Because of the significantly higher rate of prognostically advantageous meniscal repair, the recommendation for an ACL reconstruction within 6months after trauma was made to preserve the meniscus and reduce the risk of developing OA. Prospective cross-sectional cohort study, Level II.