Navigating ACL Injuries Amid the COVID-19 Pandemic: A Retrospective Analysis.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Trauma Management

Background:

• Musculoskeletal injuries, particularly acute knee injuries, are common in UK primary care and emergency departments.
• Diagnosing anterior cruciate ligament (ACL) injuries presents challenges, often causing diagnostic delays.
• The COVID-19 pandemic disrupted musculoskeletal disorder management, leading to surgical backlogs and delayed interventions.

Purpose of the Study:

• To evaluate the impact of COVID-19 on the timeline from ACL injury diagnosis to MRI and surgical intervention.
• To assess the effectiveness of an internal acute knee clinic pathway in expediting the management of soft tissue knee injuries.
• To analyze delays in ACL reconstruction and their implications for knee instability and secondary injuries.

Main Methods:

• Retrospective cross-sectional study of 97 patients undergoing primary ACL reconstruction between January 2019 and November 2022.
• Data collected included dates of injury, presentation, specialist review, MRI, surgery, and time intervals (injury-to-surgery, injury-to-MRI, MRI-to-surgery).
• Patients were divided into pre- and post-COVID groups based on operation date for comparative analysis using quantitative and qualitative tests (P < 0.05).

Main Results:

• The median injury-to-MRI time decreased slightly post-COVID (44 days) compared to pre-COVID (46.5 days), though not statistically significant (P = 0.596).
• The median injury-to-surgery time increased post-COVID (289 days) versus pre-COVID (287.5 days), showing statistical significance (P = 0.019).
• Median MRI-to-surgery duration also increased post-COVID (225 days) compared to pre-COVID (200 days) (P = 0.006), with 35% of patients having pre-specialist MRI.

Conclusions:

• The COVID-19 pandemic significantly impacted ACL injury management, causing delays in elective knee clinics and surgery.
• Despite overall pandemic-related delays, the hospital's acute knee pathway demonstrated a reduction in injury-to-surgery time post-pandemic.
• This expedited pathway is vital for managing ACL injuries, especially those with associated meniscal tears, to prevent worsening of secondary damage.