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Study links young age, meniscal tears to delayed ACL reconstruction
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Investigators of this study found delayed ACL reconstruction was significantly correlated with young age and meniscal tears.
Researchers identified 1,841 patients with new-onset isolated ACL tears. Overall, 661 patients underwent nonoperative treatment within the first year following ACL tear. Investigators reviewed medical records for diagnosis confirmation and also gathered data on clinical characteristics and subsequent ACL surgeries. Landmark survival analysis was conducted to assess the incidence of ACL reconstruction between 1 year and 10 years following the injury. Cox proportional hazards regression was used to determine predictors for early and late ACL reconstruction.
At a mean follow-up of 10 years, investigators found 213 patients underwent ACL reconstruction between 1 year and 10 years after the injury. Predictors for delayed ACL reconstruction included young age and sustaining a meniscal tear at the time of injury. Investigators noted that during the study period, the rate of delayed ACL reconstruction significantly decreased. No correlation was seen between sex and delayed ACL reconstruction. Investigators found 39% of patients who had a delayed ACL reconstruction had a subsequent meniscal tear prior to surgery. ‒ by Monica Jaramillo
Disclosures: Sanders reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Champ L. Baker Jr., MD
This is a well-written and well-documented review, with incidence and factors associated with the decision to undergo ACL reconstruction at least 1 year after injury. This is a case-controlled study based off 1,841 patients with ACL injuries. Of those, 661 patients were treated nonoperatively after the first year. Overall, 213 patients or 32% of patients underwent ACL reconstruction between 1 year and 10 years after injury, with a few patients undergoing surgery after 5 years.
As this is a review, we do not know the reason for the delayed reconstruction. We do know that gender was not associated with the need for ACL reconstruction, and the younger the patient at the time of injury and the presence of an initial meniscus tear were factors indicative of the patient requiring surgery.
As a perspective, Dale Daniel, MD, and his colleagues conducted a prospective outcome study titled “Fate of the ACL-injured patient,” which was published in the American Journal of Sports Medicine in 1994. His surgical patients were divided into early reconstruction or later reconstruction. Although the majority of his patients who required surgery had surgery within the first 4 months, 32 patients had surgery between 1 year and 8 years. These two studies, which were written more than 20 years apart, both tell us the same thing — that patients with an ACL injury who elect to forego surgery have approximately a 32% chance of requiring surgery within the next 10 years, with the majority within the next 5 years.
These people may be copers with their ACL injury, either by reduced activity or absent meniscus tears. Age at the time of injury, which Daniel linked closely with athletic activity, and a meniscus tear at the time of the initial injury were factors in requiring surgery.
The take-home message is that not all ACL injuries will require early intervention. If the surgeon and the patient decide not to operate within the first year, the chances are that one-third of those patients will require surgery. The younger the patient and the involvement of meniscus injuries initially would indicate a higher need for surgery, while the sex of the patient does not. This information is valuable in counseling our patients at the time of injury, as they may ask, “What would happen if I elected not to undergo the procedure?”
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