Summary

The intraarticular comorbidities are very common with ACL tear and these comorbidities tend to increase with chronicity of untreated ACL tear. The purpose is to study the prevalence of meniscus and chondral comorbidities, sub-regional location of the lesions, their size and depth analysis and relation with age of the patient and relation with chronicity of the untreated ACL tear.

Abstract

Purpose

The intraarticular comorbidities are very common with ACL tear and these comorbidities tend to increase with chronicity of untreated ACL tear. The purpose is to study the prevalence of chondral comorbidities, sub-regional location of the lesions, their size and depth analysis and relation with age of the patient and relation with chronicity of the untreated ACL tear.

Type of study: Retrospective Study

Methods

A retrospective analysis of three years of data from the indoor registry of the hospital, operated by single surgeon was done. From the cohort of 289 patients, 173 patients were selected after applying inclusion and exclusion criteria. Patients with incomplete data, multi-ligament injuries, and patients <20 and >50 years age group were excluded. Presence of chondral lesions were tabulated at six location namely medial femoral condyle (MFC), medial tibial plateau (MTP), lateral femoral condyle (LFC), lateral tibial plateau (LTP), trochlea and patella; and were assessed for sub-location, size and depth of lesion (ICRS Classification). Chronicity of the tear was defined in five time-zones: 0-4 weeks (T1), 4-52 weeks (T2), 52-104 weeks (T3), 105-260 weeks (T4) and > 260 weeks from injury (T5).

Results

Out of total (n=173) 65.90% of patients got operated within T1-T2 whereas 45.66% got operated in T2. Patients without any comorbidities were only 13.29%, with highest prevalence (73.91%) of comorbidities present in 20-30 age group. The medial compartment (MC) was most affected (64.74%), followed by lateral compartment (LC) (45.66%), and then patellofemoral compartment (8.09%). In MC, MFC chondral lesions were most common comorbidity with involvement in 42.20% cases respectively. The location of chondral lesion in MFC was most favoured at lateral half of weight bearing zone (59.09%) in 20-30 age group which shifted to central half (45%) in 40-50 age group. The lesion size didn’t change significantly over a period of time in all groups (1.08, 1.49, 1.22, 1.05 and 1.42 cm2 in T1, T2, T3, T4, and T5 respectively); however, the mean lesion depth (ICRS Classification) increased form 2.1 and 2.18 in T1 and T2 respectively to 2.47 in T5 with highest increase in T5 with 40-50 age group (mean ICRS depth 3.25).

Conclusion

A higher trend to get operated within one year was noted. Medial compartment is most involved compartment with higher prevalence in MFC chondral lesions, the tendency continues to increase with chronicity of the tear and with age. MFC chondral lesions don’t tend to increase in size but increase in depth with chronicity of the lesions.