Findings support early revision ACL reconstruction for recurrent instability

Delaying surgery more than 6 months was correlated with more articular cartilage damage.

Now research indicates there are more advanced changes and a significantly higher rate of articular cartilage degeneration when ACL reconstruction is delayed.

Investigators retrospectively studied 87 patients who underwent revision ACL reconstruction for recurrent instability after primary ACL reconstruction. They discovered significantly more articular cartilage degeneration in patients who had revisions more than 6 months following their primary reconstructions compared to those who had revision procedures within 6 months of the event (P<.01). They also found that 12.9% of patients who underwent revision after 6 months had partial or full-thickness tears at the time of the revision procedure, while none of the patients who had revision within 6 months did.

No difference in tear rate

However, the investigators found no significant differences between the groups regarding the rate of meniscal tears at the time of revision.

"We found that delay in revision surgery, longer than 6 months, was associated with an increased incidence and severity of articular cartilage degeneration," Nicholas E. Ohly, MRCSEd, said during his presentation at the British Orthopaedic Association Annual Congress 2007. "It gives increasing support for early revision ACL reconstruction following injury and failure of the primary graft."

Ohly and his colleagues studied 65 men and 22 women who underwent revision ACL reconstruction, at a mean age of 28.8 years with a mean time from graft failure to the revision of 20 months. The investigators divided the cohort into groups having revision surgery, either before (25) or after (26) 6 months from the index procedure.

Articular cartilage damage

"The results were significant in terms of articular cartilage damage, but there was no significant difference for meniscal injury," Ohly said. The study revealed that 53.2% of the delayed group showed articular cartilage damage compared to 24% of the early group, according to the study abstract.

A review of the meniscal pathology revealed no significant differences between the groups regarding meniscal injury potentially because a significant portion had pervious meniscal surgery, Ohly said.

For more information:
Nicholas E. Ohly, MRCSEd, is a clinical research fellow at the Royal Infirmary of Edinburgh. He can be reached at the department of orthopaedic trauma, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH 16 4SU, Scotland; +44-131-536-1000; e-mail: nickohly@hotmail.com.
Ohly NE, IR Murray, JF Keating. Revision anterior cruciate ligament reconstruction: Timing of surgery and the incidence of meniscal tears and degenerative change. Presented at the British Orthopaedic Association Annual Congress 2007. Sept. 25-28, 2007. Manchester, England.