Richard Rahardja, Hamish Love, Mark G Clatworthy, Simon W Young
{"title":"Delayed reconstruction is associated with higher rates of medial meniscus and chondral injury following ACL injury: A New Zealand ACL Registry Study.","authors":"Richard Rahardja, Hamish Love, Mark G Clatworthy, Simon W Young","doi":"10.1002/ksa.70002","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Early reconstruction for anterior cruciate ligament (ACL) rupture may be controversial, with some clinicians opting for a trial of non-operative management first. The impact of delayed surgery on outcomes is unclear, but it may be associated with an increase in secondary intra-articular pathology involving the menisci and cartilage. This study aimed to analyze the association between the timing of surgery and outcomes, including revision ACL reconstruction, concomitant meniscal and chondral injuries.</p><p><strong>Methods: </strong>Prospective data recorded in the New Zealand ACL Registry were analyzed. Primary ACL reconstructions performed between April 2014 and December 2022 were included. Timing of surgery was categorized into five groups: ≤6 weeks, 6 weeks to 3 months, 3-6 months, 6-12 months and >12 months. Revision rates and incidence of concomitant meniscal and chondral injury were compared between the five groups of surgical timing.</p><p><strong>Results: </strong>A total of 15,586 primary ACL reconstructions were analyzed, of which 1263 were performed within 6 weeks (8%), 3718 between 6 weeks to 3 months (24%), 5129 between 3 and 6 months (33%), 3223 between 6 and 12 months (21%) and 2253 more than 12 months (14%). The incidence of medial meniscal tears was greatest when surgery was delayed 6-12 months (40%, adjusted odds ratio [aOR] = 1.1, p = 0.01) and more than 12 months after injury (53%, aOR = 2.0, p < 0.001). Delayed surgery more than 3 months was associated with an increasing incidence of chondral injury (aOR > 1.3, p < 0.001). Revision rates were lowest in patients who underwent delayed surgery more than 12 months after injury (adjusted hazard ratio [HR] = 0.6, p < 0.001), but differences in activity levels, age, sex and graft choice were noted.</p><p><strong>Conclusion: </strong>Delayed ACL reconstruction is associated with a greater incidence of concomitant medial meniscal and chondral injury and should be considered when trialling non-operative management for ACL rupture.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":""},"PeriodicalIF":5.0000,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1002/ksa.70002","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Early reconstruction for anterior cruciate ligament (ACL) rupture may be controversial, with some clinicians opting for a trial of non-operative management first. The impact of delayed surgery on outcomes is unclear, but it may be associated with an increase in secondary intra-articular pathology involving the menisci and cartilage. This study aimed to analyze the association between the timing of surgery and outcomes, including revision ACL reconstruction, concomitant meniscal and chondral injuries.
Methods: Prospective data recorded in the New Zealand ACL Registry were analyzed. Primary ACL reconstructions performed between April 2014 and December 2022 were included. Timing of surgery was categorized into five groups: ≤6 weeks, 6 weeks to 3 months, 3-6 months, 6-12 months and >12 months. Revision rates and incidence of concomitant meniscal and chondral injury were compared between the five groups of surgical timing.
Results: A total of 15,586 primary ACL reconstructions were analyzed, of which 1263 were performed within 6 weeks (8%), 3718 between 6 weeks to 3 months (24%), 5129 between 3 and 6 months (33%), 3223 between 6 and 12 months (21%) and 2253 more than 12 months (14%). The incidence of medial meniscal tears was greatest when surgery was delayed 6-12 months (40%, adjusted odds ratio [aOR] = 1.1, p = 0.01) and more than 12 months after injury (53%, aOR = 2.0, p < 0.001). Delayed surgery more than 3 months was associated with an increasing incidence of chondral injury (aOR > 1.3, p < 0.001). Revision rates were lowest in patients who underwent delayed surgery more than 12 months after injury (adjusted hazard ratio [HR] = 0.6, p < 0.001), but differences in activity levels, age, sex and graft choice were noted.
Conclusion: Delayed ACL reconstruction is associated with a greater incidence of concomitant medial meniscal and chondral injury and should be considered when trialling non-operative management for ACL rupture.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
