Abstract
Purpose
The goal of our study was to investigate the associations between surgical delay, pain and meniscus, and articular cartilage lesions seen at the time of ACL reconstruction.
Methods
One hundred and sixty-two consecutive patients who had received ACL reconstruction were recruited. The preoperative International Knee Documentation Committee (IKDC) questionnaires, and cartilage and meniscal lesions seen at the time of surgery were analysed.
Results
Patients with surgery within 12 months were less likely to have meniscus injury (59.8/77.4 %, p = 0.032), and the meniscus injury was more likely to be salvageable. (56.3/36.0 %, p = 0.042). Patients with meniscal tear larger than 10 mm had higher pain intensity than tear <10 mm (mean 6.8/8.2, p = 0.007). Patients older than 35 years of age were more likely to suffer from cartilage injury (76.4/39.1 %, p = 0.004). Patients with cartilage lesions had longer surgical delay (mean 18.9/12.1 months, p = 0.033). The presence of meniscal tear increased the risk of cartilage lesions (p = 0.038, OR = 2.14). Patients with cartilage lesions had a greater pain frequency (mean 6.9/7.7, p = 0.048). Moderate correlation was found between the size of cartilage lesion and the frequency of pain (p = 0.013).
Conclusions
Increased surgical delay was associated with an increased incidence of meniscus and articular cartilage injuries in patients suffering from ACL tear; also, the meniscus was less likely to be salvageable. The presence of cartilage lesions was associated with an increased frequency of pain. Size of meniscal and cartilage lesions was significantly associated with pain.
Level of evidence
Retrospective comparative study, Level III.
Similar content being viewed by others
References
Bernstein J (2011) Early versus delayed reconstruction of the anterior cruciate ligament: a decision analysis approach. J Bone Jt Surg Am 93(9):e48
Binfield PM, Maffulli N, King JB (1993) Patterns of meniscal tears associated with anterior cruciate ligament lesions in athletes. Injury 24(8):557–561
Borchers JR, Kaeding CC, Pedroza AD, Huston LJ, Spindler KP, Wright RW (2011) Intra-articular findings in primary and revision anterior cruciate ligament reconstruction surgery: a comparison of the MOON and MARS study groups. Am J Sports Med 39(9):1889–1893
DeHaven KE (1990) Decision-making factors in the treatment of meniscus lesions. Clin Orthop Relat Res 252:49–54
Englund M (2008) The role of the meniscus in osteoarthritis genesis. Rheum Dis Clin North Am 34(3):573–579
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
Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29(5):600–613
Kaeding CC, Pedroza AD, Parker RD, Spindler KP, McCarty EC, Andrish JT (2005) Intra-articular findings in the reconstructed multiligament-injured knee. Arthroscopy 21(4):424–430
Keays SL, Newcombe PA, Bullock-Saxton JE, Bullock MI, Keays AC (2010) Factors involved in the development of osteoarthritis after anterior cruciate ligament surgery. Am J Sports Med 38(3):455–463
Lawrence JT, Argawal N, Ganley TJ (2011) Degeneration of the knee joint in skeletally immature patients with a diagnosis of an anterior cruciate ligament tear: is there harm in delay of treatment? Am J Sports Med 39(12):2582–2587
Levy BA (2010) Is early reconstruction necessary for all anterior cruciate ligament tears? N Engl J Med 363(4):386–388
Louboutin H, Debarge R, Richou J, Selmi TA, Donell ST, Neyret P, Dubrana F (2009) Osteoarthritis in patients with anterior cruciate ligament rupture: a review of risk factors. Knee 16(4):239–244
Maffulli N, Binfield PM, King JB (2003) Articular cartilage lesions in the symptomatic anterior cruciate ligament-deficient knee. Arthroscopy 19(7):685–690
Mariani PP (2011) Posterior horn instability of the medial meniscus a sign of posterior meniscotibial ligament insufficiency. Knee Surg Sports Traumatol Arthrosc 19(7):1148–1153
McDermott ID, Amis AA (2006) The consequences of meniscectomy. J Bone Jt Surg Br 88(12):1549–1556
Mitsou A, Vallianatos P (1988) Meniscal injuries associated with rupture of the anterior cruciate ligament: a retrospective study. Injury 19(6):429–431
Murrell GA, Maddali S, Horovitz L, Oakley SP, Warren RF (2001) The effects of time course after anterior cruciate ligament injury in correlation with meniscal and cartilage loss. Am J Sports Med 29(1):9–14
O’Connor DP, Laughlin MS, Woods GW (2005) Factors related to additional knee injuries after anterior cruciate ligament injury. Arthroscopy 21(4):431–438
Piasecki DP, Spindler KP, Warren TA, Andrish JT, Parker RD (2003) Intraarticular injuries associated with anterior cruciate ligament tear: findings at ligament reconstruction in high school and recreational athletes. An analysis of sex-based differences. Am J Sports Med 31(4):601–605
Richmond JC, Lubowitz JH, Poehling GG (2011) Prompt operative intervention reduces long-term osteoarthritis after knee anterior cruciate ligament tear. Arthroscopy 27(2):149–152
Salata MJ, Gibbs AE, Sekiya JK (2010) A systematic review of clinical outcomes in patients undergoing meniscectomy. Am J Sports Med 38(9):1907–1916
Slauterbeck JR, Kousa P, Clifton BC, Naud S, Tourville TW, Johnson RJ, Beynnon BD (2009) Geographic mapping of meniscus and cartilage lesions associated with anterior cruciate ligament injuries. J Bone Jt Surg Am 91(9):2094–2103
Tandogan RN, Taser O, Kayaalp A, Taskiran E, Pinar H, Alparslan B, Alturfan A (2004) Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc 12(4):262–270
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fok, A.W.M., Yau, W.P. Delay in ACL reconstruction is associated with more severe and painful meniscal and chondral injuries. Knee Surg Sports Traumatol Arthrosc 21, 928–933 (2013). https://doi.org/10.1007/s00167-012-2027-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-012-2027-1