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Timing of Anterior Cruciate Ligament Reconstruction and Implications for Meniscus Pathology and Treatment: Results from a Prospective Cohort

      Introduction

      Optimal timing of ACL reconstruction after injury continues to be debated, particularly when concomitant intra-articular pathology is present. The purpose of the present study was to report patient reported outcomes and the incidence of concomitant intra-articular pathology for patients undergoing early or delayed ACL reconstruction.

      Methods

      Patients undergoing ACL reconstruction at a single institution between January 2012 and December 2014 were prospectively enrolled. Variables of interest included patient demographic characteristics, concomitant pathology, and patient reported outcomes. Patient reported outcome measures, KOOS and WOMAC, were collected at the time of surgery and at 6 months. Univariate analysis was performed to assess short-term outcomes following ACLR, meniscus pathology and treatment as function of timing from injury to surgery.

      Results

      Injury and operative data was available for 255 patients, while 6-month patient reported outcomes were available for 161/255 (63%) patients. Patients treated with delayed reconstruction were older (28.7 years vs 23.1 years, p=0.01) and had a higher incidence of cartilage injury (16.5% vs. 7.8%, p=0.03). There were no clinical differences between groups at 6-month follow-up in terms of both KOOS and WOMAC scores. There were more medial meniscectomies in delayed reconstructions (medial- 40.5% vs 20.5%, p=0.01; lateral- 48.1% vs 31.7%, p=0.06). Conversely, the medial meniscus was more often repairable in early reconstruction (medial- 61.5% vs 20.9%, p=0.0003; lateral- 30% vs 21.2%, p=0.28).

      Conclusion

      Data from our prospective cohort suggest with increasing time from ACL injury to reconstruction, the reparability of the medial meniscus may decline. When certain tears to the meniscus are identified after injury, consideration should be given to early treatment in order to prevent propagation of intra-articular pathologies including both meniscus and articular cartilage injury.