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Original Article|Articles in Press

Delay of Timing of Anterior Cruciate Ligament Reconstruction Is Associated With Lower Risk of Arthrofibrosis Requiring Intervention

Published:February 10, 2023DOI:https://doi.org/10.1016/j.arthro.2023.01.102
Delay of Timing of Anterior Cruciate Ligament Reconstruction Is Associated With Lower Risk of Arthrofibrosis Requiring Intervention
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      Purpose

      To conduct 2 separate stratum-specific likelihood ratio analyses in patients younger than 40 year of age (<40 years) and those aged 40 and older (40+ years) at time of anterior cruciate ligament (ACL) reconstruction to define data-driven strata between ACL tear and primary isolated ACL reconstruction in which the risk of arthrofibrosis, using manipulation under anesthesia and arthroscopic lysis of adhesions as surrogates, is significantly different.

      Methods

      A retrospective cohort analysis was conducted using the PearlDiver Database. Patients who underwent ACL reconstruction were identified using the Current Procedure Terminology code 29888. Patients were stratified to those aged younger than 40 (<40) and those 40 and older (40+) at time of ACL reconstruction. The incidence of 2-year arthrofibrosis was calculated for weekly intervals from initial ACL injury to reconstruction. Stratum specific likelihood ratio analysis was conducted to determine data-driven intervals from initial ACL tear to reconstruction that optimize differences in 2-year arthrofibrosis. Following the identification of these intervals for both those <40 and 40+, multivariable analysis was conducted.

      Results

      For those <40, stratum-specific likelihood ratio analysis identified only 2 data-driven timing strata: 0-5 and 6-26 weeks. For those 40+, stratum-specific likelihood ratio analysis also only identified 2 data-driven strata: 0-9 and 10-26 weeks. A delay in ACL reconstruction from initial injury by at least 6 weeks in patients younger than 40 and at least 10 weeks in patients older than 40 years is associated with a 65% and 35% reduction of 2-year manipulation under anesthesia and arthroscopic lysis of adhesions, respectively.

      Conclusions

      Our analysis showed a delay in ACLR of at least 6 weeks in patients younger than 40 years to be associated with a 65% reduction in the risk of surgical intervention for arthrofibrosis and a delay of at least 10 weeks in patients 40 years and older to be associated with only a 35% reduction in the risk of surgical intervention for arthrofibrosis. The authors propose this difference in reduction to be multifactorial and potentially associated with mechanism of injury, activity level, and preoperative factors such as amount of physical therapy, rather than solely timing.

      Level of Evidence

      III, retrospective comparative prognostic study.
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      Article info

      Publication history

      Published online: February 10, 2023
      Accepted: January 25, 2023
      Received: June 23, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      The authors report the following potential conflicts of interest or sources of funding: S.C.T. reports leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid: board or committee member, American Association of Hip and Knee Surgeons; editorial or governing board, Arthroplasty Today and Journal of Arthroplasty and other financial or nonfinancial interests: unpaid consultant for KCI and OrthAlign. M.J.B. reports other financial or nonfinancial interests from Arthrex and Smith & Nephew. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

      Identification

      DOI: https://doi.org/10.1016/j.arthro.2023.01.102

      Copyright

      © 2023 by the Arthroscopy Association of North America

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