More than six months delay in anterior cruciate ligament reconstruction is associated with a higher risk of pre-reconstruction meniscal and chondral damage

Background: There is no consensus regarding the optimal timing of anterior cruciate ligament reconstruction (ACLR) and its clinical importance. Here, we compared the rate of the pre-reconstruction meniscus and cartilage injury, also the knee function, between the early ACLR (within six months of injury) and late ACLR (after six months of the injury). Methods: Retrospectively, 192 patients with an ACL tear who underwent ACLR within six months of injury (n=53) or after six months of injury (n=132) were included. Autograft bone patellar tendon bone was used as the graft choice. The rate of pre-reconstruction meniscal injury and chondral damage (Outerbridge classification) was compared between the two groups. The knee function, evaluated in the last follow-up using the Lysholm knee scale, was also compared. Results: The mean time from injury to surgery was 3.9±1.3 mo in the early group and 8.8±2.3 mo in the late group The pre-reconstruction meniscal injury was detected in 24 (45.3%) patients in the early ACLR group and 93 (66.9%) patients in the late ACLR group (P=0.006). Pre-reconstruction chondral damage was detected in six (11.3%) patients of the early ACLR group and 32 (23%) patients of the late ACLR group (P=0.049). The mean Lysholm knee scale was 86.7±6 (range 82-92) in the early ACLR group and 81.9±4.4 (range 80-84) in the late ACLR group (P<0.001). Conclusion: The higher rate of pre-reconstruction meniscal and chondral damage and lower functional score in the late ACLR group suggests avoiding ACLR delay more than six months after the injury. Level of Evidence: IV.