The Impact of Concomitant Pathologies on Patient Outcomes in Acute vs. Chronic ACL Reconstruction

Authors: Blake Padgett BS, Jonathan Brutti BS, Camila Torres-Caiaffa BA, Alexandra Moutafis BS, David Vasserman BS, Mendel Shloush BS, Jose Lima BS, Carlos Simon BS, Carlos Bermudez BS, Carolina Carrandi BS, Anshul Saxena BDS PhD, Matthias R. Schurhoff MD, Luis A. Vargas MD PhD, Gautam P. Yagnik MD, John E. Hechtman MD, John E. Zvijac MD, John W. Uribe MD

Background: ACL reconstruction (ACLR), a prevalent orthopedic procedure, often involves concomitant meniscal and chondral damage. Current literature lacks consistent differentiation between acute and chronic ACLR regarding short-term outcomes and their relationship with concomitant pathologies. This study compares the impact of surgical timing and the presence of meniscal and chondral pathologies on patient-reported outcomes (PROs).

Methods: This study used a historical cohort with prospectively collected PROs following ACLR. Inclusion criteria required complete pre-operative and 2-year follow-up data. Patients were categorized as acute if the injury-to-surgery interval was less than 60 days, and chronic if over 60 days. Dependent variables included IKDC, EuroQol, PROMIS Global Mental and Physical Health, KOOS, and VAS Pain scores, with time as the primary fixed effect. Intraoperative data included the location of chondral lesions and detailed meniscal injuries. A mixed linear model regression analysis examined the effect of time on outcome variables using REML across two groups (acute and chronic). Data was analyzed using Python 3.8 with pandas and statsmodels packages.

Results: Of 1235 patients, 97 met the inclusion criteria (54 chronic, 43 acute). Of these, 73 (75.3%) had an ACL tear with concomitant pathology (72.1% acute, 77.8% chronic). Medial meniscal tears were found in 45.4%, lateral tears in 60.8% with partial tears most frequently associated with the posterior horn (73.9% medial, 47.5% lateral). Medial chondral lesions were found in 22.7%, lateral in 18.6%, and patellofemoral in 41.2%. Among acute patients, 53.5% had meniscal injuries, 25.6% had chondromalacia, and 20.1% had both. Among chronic patients, 31.5% had meniscal injuries, 5.6% had chondromalacia, and 44.4% had both. Acute injuries had more meniscal tears (p < 0.048), while chronic injuries had significantly more combined meniscal and chondral pathology (p < 0.027). Chondral lesions showed no significant difference between timing of intervention. Overall, partial meniscectomies were performed in 55.6% (20.6% acute, 35% chronic) and meniscal repairs in 46.4% (23.7% acute, 22.7% chronic). Linear mixed model analysis showed a significant positive effect of time on IKDC scores (p < 0.001). Random effects analysis indicated a group variance of 2.355, highlighting variability in IKDC scores between acute and chronic groups.

Conclusion: Combined chondral lesions and meniscus pathologies were more prevalent in chronic ACL reconstruction. Acute intervention showed greater improvement in median PROs compared to delayed reconstruction. Earlier treatment plans may reduce the occurrence of combined meniscal injury and cartilage damage in ACLR and may improve patient outcomes.