2023 ISAKOS Biennial Congress ePoster
Delaying ACL Reconstruction Increases the Rate and Severity of Medial Compartment Chondral Injury
Nicolas Cance, Resident, Lyon, Rhône-Alpes FRANCE
Julien Erard, MD, Lyon FRANCE
Jobe Shatrov, MD, Willoughby, NSW AUSTRALIA
Gaspard Fournier, MD, Aix En Provence FRANCE
Stanislas Gunst, MD, Lyon FRANCE
Gianluca Ciolli, MD ITALY
Pasquale Porcelli, MD, Alessandria ITALY
Sebastien Lustig, MD, PhD, Lyon, Rhône Alpes FRANCE
Elvire Servien, MD, PhD, Prof., Lyon, Rhône Alpes FRANCE
Croix-Rousse Hospital, Lyon, Rhône-Alpes, SPAIN
FDA Status Not Applicable
Summary
Delaying ACLR for more than 12 months significantly increased the rate and severity of medial compartment chondral injury.
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Abstract
Background
Optimal timing between anterior cruciate ligament (ACL) injury and reconstruction remains debated. The aim of this study was to evaluate the relationship between the incidence of chondral injury and timing between ACL tear and ACL reconstruction. Secondary aims of the study were to evaluate the relationship between pre-injury Tegner activity scale (TAS), age, BMI, gender, and associated meniscal tear.
Hypothesis
Delaying ACLR increases the risk of chondral injury.
Methods
This was a retrospective study of consecutive ACL performed at a single center. A total of 1840 ACLR's were performed between 2012 and 2022. Inclusion criteria were all ACLR. Exclusion criteria were previous surgery on the knee, combined UKA or HTO procedure, ACL agenesis, partial ACL tear, <16 or >60 years old and patients with missing data regarding injury date. 1317 ACLR’s were included in the final analysis of this retrospective single center study, with a mean age of 31.2±10.5 [16-60], a mean BMI of 24.3±3.6 [16.0-40.2]. The mean pre-operative TAS was 6.2±1.4 [1-10]. Chondropathy was assessed during arthroscopy using International Cartilage Regeneration & Joint Preservation Society (ICRS) classification. Delay to ACLR, TAS, age, BMI, gender, medial and lateral meniscal tear were analyzed in uni- then multivariate analyses. Patients were divided in 4 groups according to the delay of the surgery: <3 months (427; 32%), 3 to 6 months (388; 29%), 6 to 12 months (248; 19%) and >12 months (254; 19%).
Results
A total of 224 (17%) patients had a medial compartment chondral injury at the time of ACLR and 115 (9%) had a lateral compartment injury. Majority of lesions were either grade I or II. Delaying ACLR >12 months significantly increased the rate (OR 1.668; p=0.018) and severity (OR 1.164; p=0.023) of medial compartment chondral injury. No correlation was found between a 3-6 or 6-12month delay and medial compartment chondral injury; but delaying reconstruction significantly increased the rate (Ptrend=0.050) and severity (Ptrend=0.026). No relationship was found between time delay to ACLR and lateral compartment chondral injury. Increasing TAS was associated with a significantly reduced rate (OR 0.889; p=0.047) and severity (OR 0.960; p=0.046) of medial compartment cartilage
injury. Medial meniscal tear increased the rate (OR 2.538, p<0.001) and severity (OR 1.337; p<0.001) of medial chondral injury. Lateral meniscal tear increased the rate (OR 2.850; p<0.001) and severity of lateral chondral injury (OR 1.215; p<0.001). Age over 30 increased the rate and the severity of both medial and lateral chondral injury (p<0.001). Increased BMI and male sex did not significantly increase the rate and severity of chondral injury.
Conclusions
Delaying ACLR for more than 12 months significantly increases both the rate and severity of medial compartment cartilage injury. Increasing Tegner score is associated with a lower rate and severity of cartilaginous lesions of the medial compartment. An age >30 and presence of a concomitant meniscal tear also increases the risk of medial and lateral compartment chondral injuries with concomitant ACL injury. Timing of ACL surgery should be tailored to the individual patients’ risk factor for associate chondral injury.