Skip to main content
SpringerLink
Log in

Timing of anterior cruciate ligament reconstruction within the first year after trauma and its influence on treatment of cartilage and meniscus pathology

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Anterior cruciate ligament (ACL) ruptures are often associated with primary meniscal and cartilage lesions. Late reconstruction of ACL-deficient knees may increase the risk of developing secondary meniscal and cartilage lesions; hence, the timing of ACL repair is of the utmost importance. Because meniscus outcome is also a potential predictor for osteoarthritis (OA), this study compared ACL repair within the first 6 months after injury to that of surgery conducted 7–12 months after injury with regard to the incidence of meniscal and cartilage lesions.

Methods

This prospective cross-sectional study included all complete isolated primary ACL ruptures treated in our institution within 1 year after trauma over a 12-month period. Exclusion criteria were revision ACL, complex ligament injuries, previous knee surgery, and missing injury data. Cartilage lesions were classified according to the score established by the International Cartilage Repair Society (ICRS score) and meniscal tears according to their treatment options.

Results

Two hundred and thirty-three of 730 patients (162 men, 71 women) with ACL repair met the inclusion criteria. 86.3 % of surgical interventions were conducted within 6 months and 13.7 % after 6 months of trauma. Severe cartilage lesions grade III–IV did not significantly differ between the different time points of ACL repair (<6 months 39.9 %; >6 months 31.3 %; p = n.s.). Medial meniscus lesions received significantly higher meniscal repair in early compared to delayed ACL repair. Significantly higher rate of meniscal repair of the medial meniscus was seen in cases of early ACL repair compared to delayed (<6 months 77.2 %, >6 months 46.7; p = 0.022). The rate of medial meniscal repair in early ACL repair was significantly higher for women (89.5–0 %; p = 0.002), however, not for men (73.3–53.8 %; p = n.s.). No differences were found for lateral meniscal lesions, with regard to neither the different time points (p = n.s.) nor the sex (p = n.s.).

Conclusions

Because of the significantly higher rate of prognostically advantageous meniscal repair, the recommendation for an ACL reconstruction within 6 months after trauma was made to preserve the meniscus and reduce the risk of developing OA.

Level of evidence

Prospective cross-sectional cohort study, Level II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Anstey DE, Heyworth BE, Price MD, Gill TJ (2012) Effect of timing of ACL reconstruction in surgery and development of meniscal and chondral lesions. Phys Sportsmed 40:36–40

    Article  PubMed  Google Scholar 

  2. Barenius B, Ponzer S, Shalabi A, Bujak R, Norlén L, Eriksson K (2014) Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial. Am J Sports Med 42:1049–1057

    Article  PubMed  Google Scholar 

  3. Binfield PM, Maffulli N, King JB (1993) Patterns of meniscal tears associated with anterior cruciate ligament lesions in athletes. Injury 24:557–561

    Article  CAS  PubMed  Google Scholar 

  4. Borchers JR, Kaeding CC, Pedroza AD, Huston LJ, Spindler KP, Wright RW, MOON Consortium and the MARS Group (2011) Intra-articular findings in primary and revision anterior cruciate ligament reconstruction surgery: a comparison of the MOON and MARS study groups. Am J Sports Med 39:1889–1893

    Article  PubMed  PubMed Central  Google Scholar 

  5. Brophy RH, Wright RW, David TS, McCormack RG, Sekiya JK, Svoboda SJ, Huston LJ, Haas AK, Steger-May K (2012) Association between previous meniscal surgery and the incidence of chondral lesions at revision anterior cruciate ligament reconstruction. Am J Sports Med 40:808–814

    Article  PubMed  PubMed Central  Google Scholar 

  6. Buckwalter JA (2002) Articular cartilage injuries. Clin Orthop Relat Res 402:21–37

    Article  Google Scholar 

  7. Chhadia AM, Inacio MCS, Maletis GB, Csintalan RP, Davis BR, Funahashi TT (2012) Are meniscus and cartilage injuries related to time to anterior cruciate ligament reconstruction? Am J Sports Med 9:1894–1899

    Google Scholar 

  8. Church S, Keating JF (2005) Reconstruction of the anterior cruciate ligament: timing of surgery and the incidence of meniscal tears and degenerative change. J Bone Joint Surg Br 87:1639–1642

    Article  CAS  PubMed  Google Scholar 

  9. Cohen M, Amaro JT, Ejnisman B, Carvalho RT, Nakano KK, Peccin MS, Teixeira R, Laurino CF, Abdalla RJ (2007) Anterior cruciate ligament reconstruction after 10 to 15 years: association between meniscectomy and osteoarthrosis. Arthroscopy 23:629–634

    Article  PubMed  Google Scholar 

  10. Demirac B, Aydemir F, Danis M, Ermutlu C (2011) Incidence of meniscal and osteochondral lesions in patients undergoing delayed anterior cruciate ligament reconstruction. Acta Orthop Traumatol Turc 45:348–352

    Google Scholar 

  11. Drawer S, Fuller CW (2001) Propensity for osteoarthritis and lower limb joint pain in retired professional soccer players. Br J Sports Med 35:402–408

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Faber KJ, Dill JR, Amendola A, Thain L, Spouge A, Fowler PJ (1999) Occult osteochondral lesions after anterior cruciate ligament rupture. Six-year magnetic resonance imaging follow-up study. Am J Sports Med 27:489–494

    CAS  PubMed  Google Scholar 

  13. Fehske K, Steinert A, Eichhorn HJ (2013) Intraoperative biological augmentation techniques for ligament surgery. Arthroskopie 26:133–138

    Article  Google Scholar 

  14. Foster A, Butcher C, Turner PG (2005) Changes in arthroscopic findings in the anterior cruciate ligament deficient knee prior to reconstructive surgery. Knee 12:33–35

    Article  CAS  PubMed  Google Scholar 

  15. Ghodadra N, Mall NA, Karas V, Grumet RC, Kirk S, McNickle AG, Garrido CP, Cole BJ, Bach BR Jr (2013) Articular and meniscal pathology associated with primary anterior cruciate ligament reconstruction. J Knee Surg 26:185–193

    Article  PubMed  Google Scholar 

  16. Granan LP, Bahr R, Lie SA, Engebretsen L (2009) Timing of anterior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: a cohort study based on the Norwegian National Knee Ligament Registry. Am J Sports Med 37:955–961

    Article  PubMed  Google Scholar 

  17. Henry S, Mascarenhas R, Kowalchuk D, Forsythe B, Irrgang JJ, Harner CD (2012) Medial meniscus tear morphology and chondral degeneration of the knee: is there a relationship? Arthroscopy 28:1124–1134

    Article  PubMed  Google Scholar 

  18. International cartilage repair Society (1998) Articular cartilage injury classification. Newsl ICRS 1:5–8

    Google Scholar 

  19. Järvelä T, Nyyssönen M, Kannus P, Paakkala T, Järvinen M (1999) Bone-patellar tendon-bone reconstruction of the anterior cruciate ligament. A long-term comparison of early and late repair. Int Orthop 23:227–231

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kujala UM, Kettunen J, Paananen H, Aalto T, Battié MC, Impivaara O, Videman T, Sarna S (1995) Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis Rheum 38:539–546

    Article  CAS  PubMed  Google Scholar 

  21. Lawrence JTR, Argawal N, Ganley TJ (2011) Degeneration of the knee joint in skeletally immature patients with a diagnosis of an anterior cruciate ligament tear: is there harm in delay of treatment? Am J Sports Med 39:2582–2587

    Article  PubMed  Google Scholar 

  22. Lee SJ, Aadalen KJ, Malaviya P, Lorenz EP, Hayden JK, Farr J, Kang RW, Cole BJ (2006) Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee. Am J Sports Med 34:1334–1344

    Article  PubMed  Google Scholar 

  23. Lee YS, Jeong YM, Sim JA, Kwak JH, Kim KH, Nam SW, Lee BK (2013) Specific compartmental analysis of cartilage status in double-bundle ACL reconstruction patients: a comparative study using pre-and postoperative MR images. Knee Surg Sports Traumatol Arthrosc 21:702–707

    Article  PubMed  Google Scholar 

  24. Leiter JR, Gourlay R, McRae S, de Korompay N, MacDonald PB (2014) Long-term follow-up of ACL reconstruction with hamstring autograft. Knee Surg Sports Traumatol Arthrosc 22:1061–1069

    Article  PubMed  Google Scholar 

  25. Magnussen RA, Pedroza AD, Donaldson CT, Flanigan DC, Kaeding CC (2013) Time from ACL injury to reconstruction and the prevalence of additional intra-articular pathology: is patient age an important factor? Knee Surg Sports Traumatol Arthrosc 21:2029–2034

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mayr HO, Weig TG, Plitz W (2004) Arthrofibrosis following ACL reconstruction—reasons and outcome. Arch Orthop Trauma Surg 124:518–522

    Article  PubMed  Google Scholar 

  27. McDermott ID, Amis AA (2006) The consequences of meniscectomy. J Bone Joint Surg Br 88:1549–1556

    Article  CAS  PubMed  Google Scholar 

  28. Michalitsis S, Vlychou M, Malizos KN, Thriskos P, Hantes ME (2015) Meniscal and articular cartilage lesions in the anterior cruciate ligament-deficient knee: correlation between time from injury and knee scores. Knee Surg Sports Traumatol Arthrosc 23:232–239

    Article  PubMed  Google Scholar 

  29. Millett PJ, Willis AA, Warren RF (2002) Associated injuries in pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear? Arthroscopy 18:955–959

    Article  PubMed  Google Scholar 

  30. Murrell GA, Maddali S, Horovitz L, Oakley SP, Warren RF (2001) The effects of time course after anterior cruciate ligament injury in correlation with meniscal and cartilage loss. Am J Sports Med 29:9–14

    CAS  PubMed  Google Scholar 

  31. Myklebust G, Bahr R (2005) Return to play guidelines after anterior cruciate ligament surgery. Br J Sports Med 39:127–131

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. O’Connor DP, Laughlin MS, Woods GW (2005) Factors related to additional knee injuries after anterior cruciate ligament injury. Arthroscopy 21:431–438

    Article  PubMed  Google Scholar 

  33. Radin EL, de Lamotte F, Maquet P (1984) Role of the menisci in the distribution of stress in the knee. Clin Orthop Relat Res 185:290–294

    Google Scholar 

  34. Rockborn P, Messner K (2000) Long-term results of meniscus repair and meniscectomy: a 13-year functional and radiographic follow-up study. Knee Surg Sports Traumatol Arthrosc 8:2–10

    Article  CAS  PubMed  Google Scholar 

  35. Rotterud JH, Sivertsen EA, Forssblad M, Engebretsen L, Aroen A (2011) Effect of gender and sports on the risk of full-thickness articular cartilage lesions in anterior cruciate ligament-injured knees. Am J Sports Med 39:1387–1394

    Article  PubMed  Google Scholar 

  36. Scheller G, Sobau C, Bülow JU (2001) Arthroscopic partial lateral meniscectomy in an otherwise normal knee: Clinical, functional, and radiographic results of a long-term follow-up study. Arthroscopy 17:946–952

    Article  CAS  PubMed  Google Scholar 

  37. Shelbourne KD, Wilckens JH, Mollabashy A, DeCarlo M (1991) Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Am J Sports Med 19:332–336

    Article  CAS  PubMed  Google Scholar 

  38. Shelbourne KD, Gray T (2009) Minimum 10-year results after anterior cruciate ligament reconstruction: how the loss of normal knee motion compounds other factors related to the development of osteoarthritis after surgery. Am J Sports Med 37:471–480

    Article  PubMed  Google Scholar 

  39. Shelbourne KD, Gray T (2000) Results of anterior cruciate ligament reconstruction based on meniscus and articular cartilage status at the time of surgery. Five-to fifteen-year evaluations. Am J Sports Med 28:446–452

    Article  CAS  PubMed  Google Scholar 

  40. Shelbourne KD, Heinrich J (2004) The long-term evaluation of lateral meniscus tears left in situ at the time of anterior cruciate ligament reconstruction. Arthroscopy 20:346–351

    Article  PubMed  Google Scholar 

  41. Slauterbeck JR, Kousa P, Clifton BC, Naud S, Tourville TW, Johnson RJ, Beynnon BD (2009) Geographic mapping of meniscus and cartilage lesions associated with anterior cruciate ligament injuries. J Bone Joint Surg Am 91:2094–2103

    Article  PubMed  Google Scholar 

  42. Smith TO, Davies L, Hing CB (2010) Early versus delayed surgery for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 18:304–311

    Article  PubMed  Google Scholar 

  43. Wojtys EM, Ashton-Miller JA, Huston LJ (2002) A gender-related difference in the contribution of the knee musculature to sagittal-plane shear stiffness in subjects with similar knee laxity. J Bone Joint Surg Am 84-A:10–16

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany

    Werner Krutsch, J. Zellner, F. Baumann, C. Pfeifer, M. Nerlich & P. Angele

  2. Sporthopaedicum, Straubing/Regensburg, Germany

    P. Angele

Authors
  1. Werner Krutsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Zellner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. F. Baumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Pfeifer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Nerlich
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Angele
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Werner Krutsch.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest or a sponsoring organization.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Krutsch, W., Zellner, J., Baumann, F. et al. Timing of anterior cruciate ligament reconstruction within the first year after trauma and its influence on treatment of cartilage and meniscus pathology. Knee Surg Sports Traumatol Arthrosc 25, 418–425 (2017). https://doi.org/10.1007/s00167-015-3830-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3830-2

Keywords

Search

Navigation