scholarly journals Anterior Cruciate Ligament Tears: The Impact of Increased Time From Injury to Surgery on Intra-articular Lesions

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096712
Author(s):  
Audrie Chavez ◽  
Andrew E. Jimenez ◽  
Dietrich Riepen ◽  
Benjamin Schell ◽  
Michael Khazzam ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Meniscal Tears ◽  
Chondral Lesions ◽  
Time Of Surgery ◽  
Cartilage Lesions ◽  
Anterior Cruciate ◽  
Time From Injury

Background: Previous research has shown that meniscal and articular cartilage lesions increase with time in the anterior cruciate ligament (ACL)–deficient knee. Purpose: To analyze the association between increased time from ACL injury to reconstruction and the presence of intra-articular lesions. Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective chart review was performed for patients who sustained an ACL injury and underwent reconstruction from January 1, 2009, to May 14, 2015. Factors analyzed included age, sex, and body mass index, as well as time from injury to surgery, the presence of meniscal tears, and the presence of cartilage lesions. The data were evaluated to quantify the association between time from ACL injury to reconstruction and presence of intra-articular lesions. Results: Overall, 405 patients were included in this study. Regarding time from injury, 27.3% patients were treated at <3 months, 23.6% at 3 to <6 months, 18% at 6 to <12 months, 13.6% at 12 to <24 months, 10.6% at 24 to <60 months, and 6.9% at ≥60 months. When compared with the group treated <3 months from injury, a significant increase in the rate of medial meniscal tears was seen in the groups treated at 6 to <12 months (odds ratio [OR], 2.2), 12 to <24 months (OR, 3.5), 24 to <60 months (OR, 7.0), and ≥60 months (OR, 6.3). A similar trend was seen with medial femoral condyle lesions in the groups treated at 6 to <12 months (OR, 2.5), 12 to <24 months (OR, 2.6), 24 to <60 months (OR, 2.6), and ≥60 months (OR, 6.9). The prevalence of lateral tibial plateau and lateral femoral condyle lesions also significantly increased with increased time between ACL injury and reconstruction, but this association was not seen until 24 to <60 months (ORs, 5.1 and 11.5, respectively). Conclusion: For patients undergoing ACL reconstruction, an interval >6 months between injury and surgery was associated with an increased prevalence of medial meniscal tears and medial compartment chondral lesions at the time of surgery. An interval >24 months between injury and surgery was associated with an increased prevalence of lateral compartment chondral lesions at the time of surgery.

scholarly journals Distribution of Bone Contusion Patterns in Acute Noncontact Anterior Cruciate Ligament–Torn Knees

2021 ◽  
Vol 49 (2) ◽  
pp. 404-409
Author(s):  
Sophia Y. Kim-Wang ◽  
Melissa B. Scribani ◽  
Michael B. Whiteside ◽  
Louis E. DeFrate ◽  
Tally E. Lassiter ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Meniscal Tears ◽  
Mri Scans ◽  
Anterior Cruciate ◽  
Operative Notes ◽  
Bone Contusions

Background: Bone contusions are commonly observed on magnetic resonance imaging (MRI) in individuals who have sustained a noncontact anterior cruciate ligament (ACL) injury. Time from injury to image acquisition affects the ability to visualize these bone contusions, as contusions resolve with time. Purpose: To quantify the number of bone contusions and their locations (lateral tibial plateau [LTP], lateral femoral condyle [LFC], medial tibial plateau [MTP], and medial femoral condyle [MFC]) observed on MRI scans of noncontact ACL-injured knees acquired within 6 weeks of injury. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We retrospectively reviewed clinic notes, operative notes, and imaging of 136 patients undergoing ACL reconstruction. The following exclusion criteria were applied: MRI scans acquired beyond 6 weeks after injury, contact ACL injury, and previous knee trauma. Fat-suppressed fast spin-echo T2-weighted MRI scans were reviewed by a blinded musculoskeletal radiologist. The number of contusions and their locations (LTP, LFC, MTP, and MFC) were recorded. Results: Contusions were observed in 135 of 136 patients. Eight patients (6%) had 1 contusion, 39 (29%) had 2, 41 (30%) had 3, and 47 (35%) had 4. The most common contusion patterns within each of these groups were 6 (75%) with LTP for 1 contusion, 29 (74%) with LTP/LFC for 2 contusions, 33 (80%) with LTP/LFC/MTP for 3 contusions, and 47 (100%) with LTP/LFC/MTP/MFC for 4 contusions. No sex differences were detected in contusion frequency in the 4 locations ( P > .05). Among the participants, 50 (37%) had medial meniscal tears and 52 (38%) had lateral meniscal tears. Conclusion: The most common contusion patterns observed were 4 locations (LTP/LFC/MTP/MFC) and 3 locations (LTP/LFC/MTP).

Secondary Meniscal Tears in Patients With Anterior Cruciate Ligament Injury: Relationship Among Operative Management, Osteoarthritis, and Arthroplasty at 18-Year Mean Follow-up

2019 ◽  
Vol 47 (7) ◽  
pp. 1583-1590 ◽  
Author(s):  
Michella H. Hagmeijer ◽  
Mario Hevesi ◽  
Vishal S. Desai ◽  
Thomas L. Sanders ◽  
Christopher L. Camp ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Acl Injury ◽  
Nonoperative Treatment ◽  
Meniscal Tears ◽  
Acl Injuries ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injury is one of the most frequent orthopaedic injuries and reasons for time loss in sports and carries significant implications, including posttraumatic osteoarthritis (OA). Instability associated with ACL injury has been linked to the development of secondary meniscal tears (defined as tears that develop after the initial ACL injury). To date, no study has examined secondary meniscal tears after ACL injury and their effect on OA and arthroplasty risk. Purpose: To describe the rates and natural history of secondary meniscal tears after ACL injury and to determine the effect of meniscal tear treatment on the development of OA and conversion to total knee arthroplasty (TKA). Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database of >500,000 patients was reviewed to identify patients with primary ACL injuries between January 1, 1990, and December 31, 2005. Information was collected with regard to ACL injury treatment, rates/characteristics of the secondary meniscal tears, and outcomes, including development of OA and conversion to TKA. Kaplan-Meier and adjusted multivariate survival analyses were performed to test for the effect of meniscal treatment on survivorship free of OA and TKA. Results: Of 1398 primary ACL injuries, the overall rate of secondary meniscal tears was 16%. Significantly lower rates of secondary meniscal tears were noted among patients undergoing acute ACL reconstruction within 6 months (7%) as compared with patients with delayed ACL reconstruction (33%, P < .01) and nonoperative ACL management (19%, P < .01). Of the 235 secondary meniscal tears identified (196 patients), 11.5% underwent repair, 73% partial meniscectomy, and 16% were treated nonoperatively. Tears were most often medial in location (77%) and complex in morphology (56% of medial tears, 54% of lateral tears). At the time of final follow-up, no patient undergoing repair of a secondary meniscal tear (0%) underwent TKA, as opposed to 10.9% undergoing meniscectomy and 6.1% receiving nonoperative treatment ( P = .28). Conclusion: Secondary meniscal tears after ACL injury are most common among patients undergoing delayed surgical or nonoperative treatment of their primary ACL injuries. Secondary tears often present as complex tears of the medial meniscus and result in high rates of partial meniscectomy.

Timing of Anterior Cruciate Ligament Reconstructive Surgery and Risk of Cartilage Lesions and Meniscal Tears

2009 ◽  
Vol 37 (5) ◽  
pp. 955-961 ◽  
Author(s):  
Lars-Petter Granan ◽  
Roald Bahr ◽  
Stein Atle Lie ◽  
Lars Engebretsen
Keyword(s):  
Anterior Cruciate Ligament ◽  
Confidence Interval ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Cartilage Lesion ◽  
Meniscal Tears ◽  
Cruciate Ligament Reconstruction ◽  
Cartilage Lesions ◽  
Degenerative Lesion ◽  
Anterior Cruciate

Background There is inadequate evidence to determine when to perform surgery on anterior cruciate ligament—deficient knees. Purpose To study the association between timing of anterior cruciate ligament reconstruction and the risk of having meniscal tears and cartilage lesions. Study Design Cohort study (prognosis); Level of evidence, 2. Methods All patients registered in the Norwegian National Knee Ligament Registry who had undergone primary anterior cruciate ligament reconstruction from 2004 and throughout 2006 were reviewed. Logistic regression analyses were used to estimate the relationship between time from injury until anterior cruciate ligament surgery and the risk of meniscal tears or cartilage lesions. Results Of a total of 3475 patients, there were 909 patients (26%) with cartilage lesions, 1638 patients (47%) with meniscal tears, and 527 patients (15%) with both cartilage and meniscal lesions. The odds of a cartilage lesion in the adult knee (>16 years) increased by 1.006 (95% confidence interval, 1.003-1.010) for each month that elapsed from injury to surgery. The cartilage in young adults (17-40 years) deteriorated further with an increase in odds of 1.03 (95% confidence interval, 1.02-1.05) related to the aging in years of the patient. The odds for meniscal tears in young adults increased by 1.004 (95% confidence interval, 1.002-1.006) for each month that elapsed since injury. The presence of 1 degenerative lesion increased the odds of having the other degenerative lesion by between 1.6 and 2.0 in all patient groups. Conclusion The odds of a cartilage lesion in the adult knee increased by nearly 1% for each month that elapsed from the injury date until the surgery date and that of cartilage lesions were nearly twice as frequent if there was a meniscal tear, and vice versa.

scholarly journals Increased Lateral Femoral Condyle Ratio Measured by MRI Is Associated with Higher Risk of Noncontact Anterior Cruciate Ligament Injury

2021 ◽  
Author(s):  
Miao He ◽  
Jie Li
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Anterior Cruciate Ligament ◽  
Diagnostic Performance ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Lateral Femoral Condyle ◽  
Anterior Cruciate

Abstract Background Studies have shown a significant association between the radiographically measured lateral femoral condyle ratio (LFCR) and anterior cruciate ligament (ACL) injury. However, it is unclear whether the the LFCR measured by magnetic resonance imaging (MRI) is associated with risk of noncontact ACL injury. Objective 1 To investigate the effect of the LFCR on the risk of noncontact ACL injury by MRI. 2 To investigate the association of the LFCR measured by MRI with multiple bone morphological risk factors and evaluate the most sensitive risk predictors of noncontact ACL injury. Methods A total of 116 patients, including 58 subjects with noncontact ACL injury and 58 age-matched and sex-matched controls with only meniscus injury, were included in this retrospective case-control study. The LFCR, lateral tibial slope (LTS), lateral tibial height (LTH), medial tibial slope (MTS), and medial tibial depth (MTD) were measured on MRI. The differences in each index between the two groups were compared, and risk factors were screened by single-factor logistic regression analysis. Indicators with P values <0.1 were included in the logistic regression equation. The critical values and areas under the curve (AUCs) of independent risk factors were determined by receiver operating characteristic (ROC) curve analysis. Finally, the diagnostic performance of each risk factor was evaluated by the Z-test. Results A total of 116 patients who met the inclusion criteria were included in the final analysis (58 cases in the noncontact ACL injury group and 58 cases in the control group). Patients with noncontact ACL injury had a higher femoral LFCR (63.5±2.7%) than patients with simple meniscus tear. Among all the risk factors for ACL injury, the AUC for the LFCR was the largest, at 0.81 (95% CI, 0.73-0.88), and when the critical value was 61.35%, the sensitivity and specificity for the diagnosis of ACL injury were 79% and 67%, respectively. Combined with the LTH (> 2.35 mm), the diagnostic performance was improved. The AUC was 0.85 (95% CI, 0.78-0.92), the sensitivity was 0.83, and the specificity was 0.76 Conclusion This study shows that an increased LFCR is related to an increased risk of noncontact ACL injury by MRI. The LFCR and LTH are the most sensitive risk factors for noncontact ACL injury and may help clinicians identify individuals prone to ACL injury, allowing prevention and intervention measures to be applied.

scholarly journals Evidence too weak to guide surgical treatment decisions for anterior cruciate ligament injury: a systematic review of the risk of new meniscal tears after anterior cruciate ligament injury

2020 ◽  
Vol 54 (9) ◽  
pp. 520-527 ◽  
Author(s):  
Guri Ranum Ekås ◽  
Clare L Ardern ◽  
Hege Grindem ◽  
Lars Engebretsen
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Surgical Treatment ◽  
Anterior Cruciate Ligament Injury ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Ligament Injury ◽  
Meniscal Tears ◽  
Anterior Cruciate

ObjectiveTo investigate the risk of new meniscal tears after treatment for anterior cruciate ligament (ACL) injury, in children and adults with and without ACL reconstruction.DesignPrognosis systematic review (PROSPERO registration number CRD42016036788).MethodsWe searched Embase, Ovid Medline, Cochrane, CINAHL, SPORTDiscus, PEDro and Google Scholar from inception to 3rd May 2018. Eligible articles included patients with ACL injury (diagnosis confirmed by MRI and/or diagnostic arthroscopy), reported the number of meniscal tears at the time of ACL injury diagnosis/start of treatment and reported the number of new meniscal tears that subsequently occurred. Articles with fewer than 20 patients at follow-up, and articles limited to ACL revision surgery or multi-ligament knee injuries were excluded. Two independent reviewers screened articles, assessed eligibility, assessed risk of bias and extracted data. We judged the certainty of evidence using the Grading of Recommendations Assessment Development and Evaluation (GRADE) working group methodology.ResultsOf 75 studies included in the systematic review, 54 studies with 9624 patients and 501 new meniscal tears were appropriate for quantitative analysis. Heterogeneity precluded data pooling. The risk of new meniscal tears was 0%–21% when follow-up was <2 years, 0%–29% when follow-up was 2 to 5 years, 5%–52% when follow-up was 5 to 10 years and 4%–31% when follow-up was longer than 10 years. The proportion of studies with high risk of selection, misclassification and detection bias was 84%, 69% and 68%, respectively. Certainty of evidence was very low.ConclusionNew meniscal tears occurred in 0%–52% of patients between 4 months and 20 years (mean 4.9±4.4 years) following treatment for ACL injury. The certainty of evidence was too low to guide surgical treatment decisions. This review cannot conclude that the incidence of new meniscal tears is lower if ACL injury is treated with surgery compared with treatment with rehabilitation only.

High Rates of Osteoarthritis Develop After Anterior Cruciate Ligament Surgery: An Analysis of 4108 Patients

2017 ◽  
Vol 46 (8) ◽  
pp. 2011-2019 ◽  
Author(s):  
Mark E. Cinque ◽  
Grant J. Dornan ◽  
Jorge Chahla ◽  
Gilbert Moatshe ◽  
Robert F. LaPrade
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Patient Age ◽  
Time Of Surgery ◽  
Patient Âgé ◽  
Anterior Cruciate ◽  
Time From Injury

Background: Posttraumatic osteoarthritis (PTOA) after anterior cruciate ligament (ACL) reconstruction ultimately translates into a large economic effect on the health care system owing to the young ages of this population. Purpose/Hypothesis: The purposes were to perform a meta-analysis to determine the prevalence of osteoarthritis after an ACL reconstruction, examining the effects of length of time after surgery, preoperative time interval from injury to surgery, and patient age at the time of surgery. It was hypothesized that the prevalence of PTOA increased with time from surgery and that increased time from injury to surgery and age were also risk factors for the development of PTOA. Study Design: Meta-analysis. Methods: A meta-analysis of the prevalence of radiographic PTOA after ACL reconstruction was performed of studies with a minimum of 5 years’ follow-up, with a level of evidence of 1, 2, or 3. The presence of osteoarthritis was defined according to knee radiographs evaluated with classification based on Kellgren and Lawrence, Ahlbäck, International Knee Documentation Committee, or the Osteoarthritis Research Society International. Metaregression models quantified the relationship between radiographic PTOA prevalence and the mean time from injury to surgery, mean patient age at time of surgery, and mean postoperative follow-up time. Results: Thirty-eight studies (4108 patients) were included. Longer postsurgical follow-up time was significantly positively associated with a higher proportion of PTOA development. The model-estimated proportion of PTOA (95% CI) at 5, 10, and 20 years after surgery was 11.3% (6.4%-19.1%), 20.6% (14.9%-27.7%), and 51.6% (29.1%-73.5%), respectively. Increased chronicity of the ACL tear before surgery and increased patient age were also associated with a higher likelihood of PTOA development. Conclusion: The prevalence of osteoarthritis after an ACL reconstruction significantly increased with time. Longer chronicity of ACL tear and older age at the time of surgery were significantly positively correlated with the development of osteoarthritis. A timely referral and treatment of symptomatic patients are vital to diminish the occurrence of PTOA.

scholarly journals Incidence of Medial and Lateral Meniscal Tears After Delayed Anterior Cruciate Ligament Reconstruction in Pediatric Patients

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096460
Author(s):  
Itaru Kawashima ◽  
Hideki Hiraiwa ◽  
Shinya Ishizuka ◽  
Ryosuke Kawai ◽  
Yoshiaki Kusaka ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Early Group ◽  
Meniscal Tears ◽  
Level Of Evidence ◽  
Surgery Patient ◽  
Delayed Group ◽  
Anterior Cruciate

Background: The treatment of pediatric anterior cruciate ligament (ACL) injuries is controversial, and no clear management guidelines have been established. Purpose: To evaluate the association between elapsed time from ACL injury to surgery and the incidence of meniscal tears and chondral injuries in patients aged ≤16 years. Study Design: Cohort study; Level of evidence, 3. Methods: Between December 2012 and April 2019, a total of 207 consecutive knees in 207 patients aged ≤16 years underwent primary ACL reconstruction and were included in this study. Patients were divided into 1 of 2 groups (early group [≤150 days] and delayed group [>150 days]) based on the time between injury and surgery. Patient records, including arthroscopic findings identified by 2 experienced knee surgeons at the time of surgery, were reviewed for demographic information, incidence and types of medial and lateral meniscal tears, and chondral injuries and their locations in each group. Results: There were 180 knees in the early group and 27 knees in the delayed group. The delayed group showed a significantly higher rate of medial meniscal tears than the early group: 16 of 27 (59.2%) and 46 of 180 (25.6%), respectively (odds ratio [OR], 4.24 [95% CI, 1.83-9.33]; P = .0011). The delayed group had a significantly lower rate of lateral meniscal tears than the early group: 6 of 27 (22.2%) and 90 of 180 (50.0%), respectively (OR, 0.29 [95% CI, 0.11-0.70]; P = .007). The delayed group had significantly higher rates of chondral injuries in the medial femoral condyle and the medial tibial plateau than the early group: 8 of 27 (29.6%) and 25 of 180 (13.9%), respectively (OR, 2.61 [95% CI, 1.03-6.62]; P = .049), and 2 of 27 (7.4%) and 1 of 180 (0.6%), respectively (OR, 14.32 [95% CI, 1.58-208.10]; P = .045). Conclusion: Delayed ACL reconstruction was associated with an increased incidence of medial chondral injuries and medial meniscal tears but with a decreased incidence of lateral meniscal tears.

Degeneration of the Knee Joint in Skeletally Immature Patients With a Diagnosis of an Anterior Cruciate Ligament Tear

2011 ◽  
Vol 39 (12) ◽  
pp. 2582-2587 ◽  
Author(s):  
J. Todd R. Lawrence ◽  
Nina Argawal ◽  
Theodore J. Ganley
Keyword(s):  
Anterior Cruciate Ligament ◽  
Odds Ratio ◽  
Cruciate Ligament ◽  
Lateral Compartment ◽  
Surgical Reconstruction ◽  
Skeletally Immature ◽  
Meniscal Tears ◽  
Cartilage Injuries ◽  
Anterior Cruciate ◽  
Time From Injury

Background: In skeletally immature patients with an anterior cruciate ligament (ACL) tear and significant growth remaining, the risk of inducing a growth disturbance with early reconstruction must be balanced against the risk of further intra-articular damage by delaying treatment until closer to skeletal maturity. Hypothesis: Increased time from injury to ACL reconstruction in children ≤14 years of age will be associated with increased meniscal and chondral injuries at the time of reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: With institutional review board approval, the records of a consecutive series of patients 14 years of age and younger who underwent ACL reconstruction between 1991 and 2005 were reviewed. Demographic, magnetic resonance imaging (MRI), and intraoperative findings were analyzed. Meniscal and articular cartilage injuries were graded. Logistic regression models using both univariable and multivariable regression procedures were used to identify factors independently associated with intra-articular lesions. Fisher exact test and Kaplan-Meier analysis were used to test for differences in intra-articular injuries by time from injury to surgery. Results: Seventy patients were identified. Twenty-nine patients (41%) underwent reconstruction more than 12 weeks from the time of injury. Logistic regression analysis revealed time to surgical reconstruction (odds ratio, 4.1) and a history of a sense of knee instability (odds ratio, 11.4) to be independently associated with medial meniscal tears. Time to surgical reconstruction was also independently associated with medial and lateral compartment chondral injuries (odds ratios, 5.6 and 11.3, respectively). Testing time as a continuous variable, survivorship analysis also confirmed a significant association of time to reconstruction with medial meniscal injury as well as lateral and patellotrochlear cartilage injuries. When present, a delay in treatment of over 12 weeks (29 patients) was associated with an increase in the severity of medial meniscal tears ( P = .011) and higher grade lateral and patellotrochlear chondral injuries ( P = .0014 and P = .038, respectively). Conclusion: Young patients who underwent surgical reconstruction of an acute ACL tear >12 weeks after the injury were noted to have a significant increase in irreparable medial meniscal tears and lateral compartment chondral injuries at the time of reconstruction. When a subjective sense of knee instability was present, this association was even stronger.

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