Affiliation:
1. Department of Orthopaedic Surgery Baylor College of Medicine Houston Texas USA
2. MITRE Corporation McLean Virginia USA
3. Dartmouth Health Cheshire Medical Center Keene New Hampshire USA
4. Orthopedic Surgery Southern California Orthopedic Institute Van Nuys California USA
Abstract
AbstractPurposeAnterior cruciate ligament (ACL) injuries are becoming more common in youth athletes. Time‐to‐surgery has been shown to significantly affect the rates of concurrent injuries at the time of ACL reconstruction (ACLR). The purpose of this study was to evaluate if time‐to‐surgery in ACLR impacts observances of intra‐articular injuries and to categorize injury profile in relation to time.MethodsAn Institutional Review Board‐approved retrospective cohort study was conducted. Included subjects were aged 21 and below and underwent primary ACLR within 6 months of injury between January 2012 and April 2020. Skeletal maturity was determined via imaging. Laterality, location and severity/pattern of meniscal and chondral injuries were recorded. Multivariate logistic regression was utilized to identify risk factors for intra‐articular pathology. Cut‐off analyses were added to regression models to identify trends of concurrent injuries.ResultsEight hundred and fifty patients met the inclusion criteria. Patients with observed articular cartilage injuries had a significantly longer time‐to‐surgery of 66 days (p = 0.01). Risk factors for chondral injury were time‐to‐surgery (p = 0.01) and skeletal maturity (p = 0.01), while medial meniscal tears were prognosticated by time‐to‐surgery (p = 0.03), skeletal maturity (p = 0.01) and body mass index (p = 0.00). Cut‐off analysis showed that after 40 days the proportion of patients with observed chondral injury increased with time to surgery and that there were significantly different observances of chondral (p = 0.00) and medial meniscal (p = 0.03) injuries in the 6‐week model, as compared to the continuous time model.ConclusionLonger time‐to‐surgery in ACLR is associated with higher rates of concomitant intra‐articular pathology, especially chondral injuries. After 40 days, the observed rates of intra‐articular injury increase proportionately with time from injury. A 6‐week categorical model best stratifies intra‐articular injury risk profile. Risk factor analysis identified skeletally mature patients with delayed surgery of >12 weeks to be at the highest risk for both chondral and medial meniscal injuries after an ACLR.Level of EvidenceLevel III.