Demographic Factors Associated With an Increased Incidence of Intra-articular Injuries After Delayed Anterior Cruciate Ligament Reconstruction

Dietrich Riepen; Gregory Kanski; Audrie Aliza Chavez; Paul Tavakolian; Christian Gronbeck; Michael Khazzam; Katherine J Coyner

doi:10.1177/23259671211073905

Demographic Factors Associated With an Increased Incidence of Intra-articular Injuries After Delayed Anterior Cruciate Ligament Reconstruction

Orthop J Sports Med. 2022 Mar 31;10(3):23259671211073905. doi: 10.1177/23259671211073905. eCollection 2022 Mar.

Authors

Dietrich Riepen¹, Gregory Kanski², Audrie Aliza Chavez¹, Paul Tavakolian¹, Christian Gronbeck², Michael Khazzam¹, Katherine J Coyner²

Affiliations

¹ University of Texas Southwestern Medical Center, Dallas, Texas, USA.
² UConn Health, Farmington, Connecticut, USA.

Abstract

Background: Delays from the time of an anterior cruciate ligament (ACL) tear to surgical reconstruction are associated with an increased incidence of meniscal and chondral injuries.

Purpose: To evaluate the association between delays in ACL reconstruction (ACLR) and risk factors for intra-articular injuries across 8 patient demographic subsets.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: We performed a retrospective chart review of all patients who underwent ACLR from January 2009 to May 2015 at a single institution. Variables collected were age, sex, body mass index, time from injury to surgery, and presence of meniscal tears and chondral injuries. Demographic subsets were created according to sex, age (<27 vs ≥27 years), body mass index (<25 vs ≥25 kg/m²), and injury setting (sports vs non-sports related). Subsets were divided by time from injury to ACLR: 0 to <6 months (control group), 6 to <12 months, and ≥12 months. Multivariate logistic regression-generated odds ratios (ORs) were calculated.

Results: Overall, 410 patients were included. ORs were significant for an increased incidence of medial meniscal tears (MMTs) (OR, 1.12-3.72; P = .02), medial femoral condyle (MFC) injuries (OR, 1.18-4.81; P = .02), and medial tibial plateau (MTP) injuries (OR, 1.33-31.07; P = .02) with surgical delays of 6 to <12 months. With ≥12-month delays, significance was found for MMTs (OR, 2.92-8.64; P < .001), MFC injuries (OR, 1.86-5.88; P < .001), MTP injuries (OR, 1.37-21.22; P = .02), lateral femoral condyle injuries (OR, 2.41-14.94; P < .001), and lateral tibial plateau injuries (OR, 1.15-5.27; P = .02). In the subset analysis, differences in the timing, location, rate, and pattern of chondral and meniscal injuries became evident. Female patients and patients with non-sports-related ACL tears had less risk of associated injuries with delayed surgery, while other demographic groups showed an increased injury risk.

Conclusion: When analyzing patients who were symptomatic enough to eventually require surgery, an increased incidence of MMTs and medial chondral injuries was associated with ≥6-month delays in ACLR, and an increased incidence of lateral chondral injuries was associated with ≥12-month delays. Female patients and patients with non-sports-related ACL tears had less risk of injuries with delayed ACLR.

Keywords: ACL; delayed; demographics; injury.