Skip to main content

Advertisement

Log in

Prevalence and consequences of delayed diagnosis of anterior cruciate ligament ruptures

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

Abstract

Purpose

Rupture of the anterior cruciate ligament (ACL) is a common injury, often presenting with a typical injury pattern. Historically, the literature indicates that the accuracy of diagnosis of ACL ruptures is poor at the initial medical consultation. The aims of this study were to determine: the mechanism of injury; changes in accuracy of diagnosis of ACL ruptures at initial presentation over the last decade; and the effect of subsequent delay in diagnosis and definitive treatment.

Methods

A prospective cohort of one hundred and thirty-two consecutive patients who underwent ACL reconstruction between 2005 and 2009 were analysed. The median age of the patients was 18 years (12–57). Sixteen patients were excluded due to chronic ACL injury.

Results

One hundred and sixteen patients (117 ACL ruptures) were included in the analysis. A typical injury pattern was documented in 87 (74.4 %) of cases. The most common sporting activities associated with an ACL injury were football (35.3 %), skiing (21.6 %) and rugby (10.3 %). The majority of patients (67.5 %) sought medical attention within 1 week from time of injury. The correct diagnosis of an ACL rupture was made in 33 cases (28.2 %) at the initial medical consultation. The diagnosis was made following medical consultation in 13 (11.1 %) of cases with the use of magnetic resonance imaging and 6 (5.1 %) cases at arthroscopy. The median time to diagnosis was 6 weeks (0–192), and the median time to ACL reconstruction was 24 weeks (1–240). A delay in diagnosis of >6 months was associated with a medial meniscal tear rate of 72.2 % compared to 23.1 % if the diagnosis was made within 4 months of the injury (p < 0.05).

Conclusions

Despite a ‘typical’ mechanism of injury leading to ACL rupture, the rate of initial diagnosis in the UK still remains poor. This often leads to an unnecessary delay in the diagnosis and subsequent treatment and increases the risk of secondary injury to the knee. A delay in diagnosis of >6 months was associated with an increased medial meniscal tear rate. Patients who present with a ‘typical’ injury pattern should therefore be referred for further assessment by a knee specialist within 6 weeks.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Ball S, Haddad FS (2010) The impact of an acute knee clinic. Ann R Coll Surg Engl 92(8):685–688

    Article  PubMed Central  PubMed  Google Scholar 

  2. Benjaminse A, Gokeler A, van der Schans CP (2006) Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther 36(5):267–288

    Article  PubMed  Google Scholar 

  3. Bollen SR, Scott BW (1996) Rupture of the anterior cruciate ligament–a quiet epidemic? Injury 27(6):407–409

    Article  CAS  PubMed  Google Scholar 

  4. Bourke HE, Gordon DJ, Salmon LJ, Waller A, Linklater J, Pinczewski LA (2012) The outcome at 15 years of endoscopic anterior cruciate ligament reconstruction using hamstring tendon autograft for ‘isolated’ anterior cruciate ligament rupture. J Bone Joint Surg Br 94(5):630–637

    Article  CAS  PubMed  Google Scholar 

  5. Brophy RH, Wright RW, Matava MJ (2009) Cost analysis of converting from single-bundle to double-bundle anterior cruciate ligament reconstruction. Am J Sports Med 37(4):683–687

    Article  PubMed  Google Scholar 

  6. Chhadia AM, Inacio MC, Maletis GB, Csintalan RP, Davis BR, Funahashi TT (2011) Are meniscus and cartilage injuries related to time to anterior cruciate ligament reconstruction? Am J Sports Med 39(9):1894–1899

    Article  PubMed  Google Scholar 

  7. Church S, Keating JF (2005) Reconstruction of the anterior cruciate ligament: timing of surgery and the incidence of meniscal tears and degenerative change. J Bone Joint Surg Br 87(12):1639–1642

    Article  CAS  PubMed  Google Scholar 

  8. Foster A, Butcher C, Turner PG (2005) Changes in arthroscopic findings in the anterior cruciate ligament deficient knee prior to reconstructive surgery. Knee 12(1):33–35

    Article  CAS  PubMed  Google Scholar 

  9. Fowler PJ, Regan WD (1987) The patient with symptomatic chronic anterior cruciate ligament insufficiency. Results of minimal arthroscopic surgery and rehabilitation. Am J Sports Med 15(4):321–325

    Article  CAS  PubMed  Google Scholar 

  10. Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS (2010) A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med 363(4):331–342

    Article  CAS  PubMed  Google Scholar 

  11. Guillodo Y, Rannou N, Dubrana F, Lefevre C, Saraux A (2008) Diagnosis of anterior cruciate ligament rupture in an emergency department. J Trauma 65(5):1078–1082

    Article  PubMed  Google Scholar 

  12. Hartnett N, Tregonning RJ (2001) Delay in diagnosis of anterior cruciate ligament injury in sport. N Z Med J 114(1124):11–13

    CAS  PubMed  Google Scholar 

  13. Kocabey Y, Tetik O, Isbell WM, Atay OA, Johnson DL (2004) The value of clinical examination versus magnetic resonance imaging in the diagnosis of meniscal tears and anterior cruciate ligament rupture. Arthroscopy 20(7):696–700

    Article  PubMed  Google Scholar 

  14. Lohmander LS, Englund PM, Dahl LL, Roos EM (2007) The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 35(10):1756–1769

    Article  PubMed  Google Scholar 

  15. Michalitsis S, Vlychou M, Malizos KN, Thriskos P, Hantes ME (2013) Meniscal and articular cartilage lesions in the anterior cruciate ligament-deficient knee: correlation between time from injury and knee scores. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2497-9

    PubMed  Google Scholar 

  16. Millett PJ, Willis AA, Warren RF (2002) Associated injuries in pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear? Arthroscopy 18(9):955–959

    Article  PubMed  Google Scholar 

  17. Noyes FR, Paulos L, Mooar LA, Signer B (1980) Knee sprains and acute knee hemarthrosis: misdiagnosis of anterior cruciate ligament tears. Phys Ther 60(12):1596–1601

    CAS  PubMed  Google Scholar 

  18. O’Connor KM, Monteiro SK, Hoelker IA (2009) Comparison of selected lateral cutting activities used to assess ACL injury risk. J Appl Biomech 25(1):9–21

    PubMed  Google Scholar 

  19. Rose NE, Gold SM (1996) A comparison of accuracy between clinical examination and magnetic resonance imaging in the diagnosis of meniscal and anterior cruciate ligament tears. Arthroscopy 12(4):398–405

    Article  CAS  PubMed  Google Scholar 

  20. Sri-Ram K, Salmon LJ, Pinczewski LA, Roe JP (2013) The incidence of secondary pathology after anterior cruciate ligament rupture in 5,086 patients requiring ligament reconstruction. Bone Joint J 95-B(1):59–64

    Article  CAS  PubMed  Google Scholar 

  21. van Eck CF, van den Bekerom MP, Fu FH, Poolman RW, Kerkhoffs GM (2013) Methods to diagnose acute anterior cruciate ligament rupture: a meta-analysis of physical examinations with and without anaesthesia. Knee Surg Sports Traumatol Arthrosc 21(8):1895–1903

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. H. Arastu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arastu, M.H., Grange, S. & Twyman, R. Prevalence and consequences of delayed diagnosis of anterior cruciate ligament ruptures. Knee Surg Sports Traumatol Arthrosc 23, 1201–1205 (2015). https://doi.org/10.1007/s00167-014-2947-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-2947-z

Keywords

Navigation