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Delayed anterior cruciate ligament reconstruction increases the incidence of medial meniscal bucket handle tears and medial compartment chondral injuries in patients aged 40 years and older

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

No widely accepted evidence-based indications exist for the initial surgical management of patients with anterior cruciate ligament (ACL) injuries ≥ 40 years old, and treatment for these patients remains controversial. This study aimed to evaluate the association between elapsed time from ACL injury to surgery and the incidence of meniscal tears and chondral injury in patients aged ≥ 40 years.

Materials and methods

The patients who underwent primary ACL reconstruction were divided into two groups based on elapsed time from injury to surgery: early group, < 12 months; and delayed group, ≥ 12 months. Patient records were reviewed for incidence and types of meniscal tears and chondral injuries in each group. Chondral injury grades were evaluated with International Cartilage Regeneration and Joint Preservation Society (ICRS) Criteria.

Results

This study evaluated 67 knees in the early group and 33 knees in the delayed group. Mean ages in each group were 46.9 ± 6.5 and 46.9 ± 6.0. The delayed group showed significantly higher rates of medial meniscal tear [31 of 33, 93.9% vs 29 of 67, 43.3%; P < 0.0001; odds ratio (OR), 20.31; 95% confidence interval (CI), 4.49–91.9], medial femoral condyle chondral injuries ≥ ICRS grade II (15 of 33, 45.5% vs 8 of 67, 11.9%; P < 0.001; OR, 6.15; 95% CI 2.24–16.83), and medial tibial chondral injuries ≥ ICRS grade II (7 of 33, 21.2% vs 3 of 67, 4.5%; P < 0.05; OR, 5.74; 95% CI 1.38–23.9) compared with the early group. With respect to types of medial meniscal tear, the delayed group showed a significantly higher frequency of bucket handle tears (11 of 33, 33.3%) compared with the early group (2 of 67, 3.0%; P < 0.0001; OR, 16.25; 95% CI 3.34–79.1).

Conclusions

Delayed ACL reconstruction was associated with increased incidence of chondral injuries and medial meniscal tears, particularly bucket handle tears in this cohort.

Level of evidence

Level III.

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Funding

There was no funding for the research for this manuscript for the authors.

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Authors and Affiliations

  1. Asahi University Hospital, Gifu, Japan

    Itaru Kawashima, Takashi Tsukahara & Ryosuke Kawai

  2. Department of Orthopaedic Surgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu, 500-8523, Japan

    Itaru Kawashima, Takashi Tsukahara & Ryosuke Kawai

  3. Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan

    Itaru Kawashima, Shinya Ishizuka, Hideki Hiraiwa & Shiro Imagama

  4. Department of Orthopaedic Surgery, Toyota Memorial Hospital, 1-1 Heiwa-cho, Toyota, Aichi, 471-8513, Japan

    Tadahiro Sakai

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  1. Itaru Kawashima
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  2. Takashi Tsukahara
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  3. Tadahiro Sakai
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  4. Ryosuke Kawai
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Correspondence to Itaru Kawashima.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors. This study was approved by the institutional review board and ethics committee of Asahi University Hospital.

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Informed consent was obtained from the patient included in this study.

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Kawashima, I., Tsukahara, T., Sakai, T. et al. Delayed anterior cruciate ligament reconstruction increases the incidence of medial meniscal bucket handle tears and medial compartment chondral injuries in patients aged 40 years and older. Arch Orthop Trauma Surg 141, 971–975 (2021). https://doi.org/10.1007/s00402-020-03745-4

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  • DOI: https://doi.org/10.1007/s00402-020-03745-4

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