Intra-Articular Pathology Associated with Acute and Chronic Anterior Cruciate Ligament Reconstruction

Concomitant meniscal and chondral pathology is common at the time of anterior cruciate ligament reconstruction (ACL-R). The purpose of the present study was to report the prevalence of concomitant intra-articular pathology for patients undergoing acute or chronic anterior cruciate ligament reconstruction.

This study represents a prospective, consecutively collected cohort of 255 patients undergoing both primary and revision ACL-R between January 2012 and December 2014 at a single institution. The cohort was divided into an acute surgical group, defined as surgery within six weeks of injury, and a chronic surgical group, greater than six weeks removed from injury. The median time from injury to surgery for the entire cohort was 37 days (range: 4 days to 855 days). Variables of interest included patient demographic characteristics, concomitant meniscal and chondral pathology, and meniscus treatment.

Patients treated in the chronic setting were slightly older (28.7 ± 11.6 years vs. 23.1 ± 8.6 years, P=0.001), had a higher prevalence of complex tears of the medial meniscus (37.2% vs. 7.7%, P=0.012) and cartilage injury (16.5% vs. 7.8%, P=0.03). After excluding revision ACL-R procedures, complex medial meniscus tears in chronic ACL-R were higher than in acute ACL-R (medial= 27.3% vs. 3.0%, P=0.022), however when age was considered, these tears were no longer more frequent than in the acute setting (P=0.056). Similarly, the prevalence of cartilage injury was equivalent between groups after correcting for age (P=0.167). Among primary ACL-R, there were more medial meniscus repairs in the acute surgical group compared to the chronic group (60.6% vs. 24.2%, P=0.003). After excluding complex tears, medial meniscus repair rates were no longer performed more frequently in patients undergoing acute ACL-R (59.4% vs. 33.3%, P=0.054).

Data from this prospective cohort suggest that with increasing time from ACL injury to ACL-R, medial meniscus pathology increases, with a lower likelihood of meniscal repair in all patients undergoing ACL-R. However, this finding is no longer statistically significant when considering only patients undergoing primary ACL-R. Age appears to play an important role in whether concomitant pathology develops following ACL rupture. Given these findings, early intervention may increase the ability to repair medial meniscus tears in the setting of ACL-R, but this conclusion is less supported in primary ACL-R.Level of Evidence: II.