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Delayed ACL reconstruction associated with higher meniscal tear rate

ACL reconstruction patients treated more than 12 months after injury had a two to three times higher incidence of degenerative change.

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Patients who undergo anterior cruciate ligament reconstruction 12 months or more after the initial injury may be at increased risk for meniscal tears and knee degeneration, according to a study by researchers in Scotland.

John F. Keating, FRCSEd(Orth), a consultant orthopedic surgeon at the Royal Infirmary of Edinburgh, and colleagues reviewed the records of 183 ACL reconstruction patients treated between 1996 and 2002. This included 135 men and 48 women with a mean age of 27 years. All patients were younger than 40 years.

Patients underwent ACL reconstruction at an average 27 months following injury, ranging from one week to 248 months. Surgeons used a quadruple hamstring graft in 159 patients and a middle-third patellar tendon graft in 24 patients.

To compare the incidence of meniscal tears and degenerative changes with time of surgery, the researchers divided patients into two groups. The early reconstruction group included 103 patients treated within 12 months of injury. The late reconstruction group included 80 patients treated 12 months or more after injury.

“There was a significant difference in the incidence of meniscal tears between patients treated in the early group and in those undergoing reconstruction of the ACL after 12 months (P<.001),” the authors said in the study.

Patients in the early surgery group had 21 (20.4%) medial meniscal tears compared with 32 (40%) tears in the delayed surgery group. The delayed surgery group also had a higher incidence of concomitant medial and lateral meniscal tears. Nine delayed surgery patients (11.2%) had such tears compared with four (3.8%) early surgery patients, according to the study.

Both groups had similar rates of lateral meniscal tears — 18 (17.5%) in the early surgery group and 16 (20%) in the delayed surgery group, however.

The delayed surgery group also had significantly higher rates of grades 1, 2, 3 and 4 degenerative change (P<.001), graded according to the French Society of Arthroscopy system. Specifically, the delayed surgery group had an incidence of grades 2, 3 and 4 degenerative change three times higher than the early surgery group, and nearly a two times higher incidence of grade 1 changes, according to the study.

The authors noted that the increased incidence of meniscal tears patients treated after 12 months resulted mainly from an increase in medial meniscal tears, as the incidence of lateral meniscal tears remained relatively unchanged.

“This may indicate that lateral meniscal tears occur at the time of injury to the ACL or very soon after injury, whereas medial meniscal tears are acquired after the knee has been ACL-deficient for more than 12 months,” the study authors said.

For more information:

• Church S, Keating JF. Reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br. 2005;87-B:1639-1642.