Delayed ACL Reconstruction


R.L.Morgan-Jones, Greg Solis, M.J.Cross

To determine the incidence of intra-articular pathology resulting from delayed Anterior Cruciate Ligament (ACL) reconstruction, we reviewed 1960 patients who had undergone a primary ACL reconstruction. There were 1443 males and 517 females, with an average age of 28.3 years. The average age at injury was 25.4 years. 1136 patients (58%) had secondary intra-articular pathology.

Of these, 621 (54.7%) had a medial meniscal tear, 594 (52.4%) had a lateral meniscal tear and 381 (33.5%) had chondral damage. The average time from injury to reconstruction was 2.9 years (34.8 months). Those with secondary intra-articular pathology presented for reconstruction later, average 3.9 years (46.8 months), compared to those without secondary pathology, average 1.5 years (18 months). The incidence of secondary intra-articular pathology increased with delay between original ACL injury and reconstruction. 41% of those waiting 12 months; 60% of those waiting 3 years; 79% of those waiting 5 years and 88% of those waiting 10 years had secondary intra-articular pathology.

This study confirms the relationship between an unstable ACL deficient knee and the incidence of secondary intra-articular pathology. Furthermore our study reveals the increasing incidence of meniscal and chondral pathology the greater the delay from injury to ACL reconstruction. To prevent unnecessary secondary intra-articular pathology we recommend ACL reconstruction is performed with minimal delay.