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

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

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 2 years.

Methods

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.

Results

Of 11,867 patients who underwent ACLR, 76.1% underwent surgery within 2 months of injury diagnosis. Patients aged 10–19 were most likely to undergo surgery within 2 months of injury diagnosis (83.5%, P < 0.0001). As duration from injury diagnosis to ACLR increased from < 2 months to > 6 months, 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 > 6 months 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 < 2 months after diagnosis (P < 0.0001). ACLR at 6–8 weeks after diagnosis demonstrated the lowest risk for concomitant procedures as well as 2-year subsequent surgery.

Conclusion

The majority of patients undergo ACL reconstruction within 2 months of initial ACL tear diagnosis. Delayed surgery greater than 6 months after the diagnosis of an ACL rupture leads to increased need for concomitant meniscectomy as well as higher risk for revision ACLR within 2 years, but immediate surgery may increase risk for knee arthrofibrosis.

Level of evidence

IV

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on request.

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Funding

This study did not receive any outside funding.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California-San Francisco, 500 Parnassus Avenue, MU West 320, San Francisco, CA, 94143, USA

    Ryan D. Freshman, Nicole M. Truong, Nicolas Cevallos, Drew A. Lansdown, Brian T. Feeley, C. Benjamin Ma & Alan L. Zhang

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  1. Ryan D. Freshman
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  2. Nicole M. Truong
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  3. Nicolas Cevallos
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  4. Drew A. Lansdown
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  5. Brian T. Feeley
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  6. C. Benjamin Ma
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  7. Alan L. Zhang
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Corresponding author

Correspondence to Ryan D. Freshman.

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The authors declare that they have no conflict of interest.

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This study was granted Exempt status from the UCSF Institutional Review Board (#21-3336).

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Freshman, R.D., Truong, N.M., Cevallos, N. et al. Delayed ACL reconstruction increases rates of concomitant procedures and risk of subsequent surgery. Knee Surg Sports Traumatol Arthrosc 31, 2897–2905 (2023). https://doi.org/10.1007/s00167-022-07249-z

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  • DOI: https://doi.org/10.1007/s00167-022-07249-z

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