Anterior Cruciate Ligament Tears: Impact of Delayed Presentation on Intra-Articular Injuries

BACKGROUND: Chronic anterior cruciate ligament (ACL) injury is associated with increased risk for meniscal and chondral injuries. This study aims to establish specifically what meniscal and chondral injuries occur in the setting of chronic ACL deficiency. UTSW and Parkland treat many chronically ACL-deficient patients, thus offering unique insight into the natural history of ACL-deficient knees. METHODS: Retrospective chart review was conducted for all patients who underwent ACL reconstruction at UTSW or Parkland from 1/1/2009 to 5/4/2015. Variables studied were age, gender, BMI, chondroplasty performed, microfracture performed, medial meniscus tear (MMT), lateral meniscus tear (LMT), and injury to the medial femoral condyle (MFC), lateral femoral condyle (LFC), medial tibial plateau (MTP), lateral tibial plateau (LTP), and patellofemoral (PF) joint. RESULTS: Four hundred and ten subjects were included in this study. Average patient age was 27+8.8 years. 58.5% had BMI >25. Males comprised 70.5% of patients. Approximately 27.1% received surgery less than 3 months after injury, 23.4% from 3 to < 6 months, 17.8% from 6 to < 12 months, 23.9% from 12 to < 60 months, and 6.8% 60+ months. Male gender and older age were predictive factors for delayed reconstruction (P<.01). MMTs were correlated with both MFC injury (OR 4.8) and MTP injury (OR 2.6), while LMTs were only correlated with LTP injury (OR 2.0). Frequency of MMT was increased with surgical delay. Compared to delays of 0 to less than 3 months, MMTs were more common in patients with delays of 6 to < 12 months (OR 2.1), 12 to < 60 months (OR 4.2) and 60+ months (OR 6.2). A similar trend characterized MFC injury. Compared to the 0 to < 3 month group, MFC injury was more likely to occur with delays of 6 to < 12 months (OR 2.7), 12 to < 60 months (OR 3.1), and 60+ months (OR 8.3). LTP and LFC injury were only associated with surgical delays of 12 to < 60 months (P<.05) and 60+ months (P<.001). Microfracture and chondroplasty were more likely to be performed in patients with delays of 12 to < 60 months (P<.001). CONCLUSION: Delaying ACL surgery for 6 months or longer is associated with an increased presence of medial meniscus tears and chondral injury (MFC, LFC, and LTP), with increased incidence in longer delays. This data supports not delaying surgery more than 6 months following an ACL tear to prevent the incidence of secondary meniscus tears and articular cartilage injury. In addition, particular attention should be paid to those who are of older age and male gender as they are at increased risk for worse cartilage and meniscus injury.