A Comparison between Early and Delayed Arthroscopic Anterior Cruciate Ligament Reconstruction: A Prospective Cohort Study

Abstract

Introduction: A complete Anterior Cruciate Ligament (ACL) injury can result in a progressively increasing symptomatic knee instability, which can cause recurrent intra articular damage and eventually results in osteoarthritis if not treated on time. Aim: To analyse the effects of delaying ACL reconstruction beyond a period of 12 weeks and compared the results with cases managed before that time period. Materials and Methods: A prospective cohort study was conducted between July 2017 to October 2019 in Government Medical College, Jammu on two groups of patients divided into early (<12 weeks) and delayed (>12 weeks) on the basis of interval between the injury and definitive surgery. ACL reconstruction was done using a quadrupled semitendinosus-gracilis graft. A standard rehabilitation protocol was followed and the results were compared. Patients were followed-up till one year postsurgery. Software used for statistical analysis was EpiInfo Version 3.0 and SPSS. Results: A total of 72 patients were included in the study. Forty patients were in the early group and 32 in delayed. Male patients outnumbered the females in both the groups and the incidence of injury was more on the right side. Sports injuries were the most common mode of injury, followed by falls and road traffic accidents in both the groups. The incidence of grade 3/4 medial and Lateral Meniscal (LM) tears was more in the delayed group and the association was statistically significant (p<0.05). There was significant thigh wasting in the delayed group (p<0.05). Two patients were lost to follow-up and were not included in the study. Conclusion: Delay in ACL reconstruction surgery predisposes to higher grade meniscal lesions and significant thigh wasting and hence the surgery should be preferably done within the first 12 weeks after injury.