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Delayed Anterior Cruciate Ligament Repair

Purpose:

We wished to determine whether instability in the knee resulting from tear of the Anterior Cruciate Ligament (ACL) could lead to additional damage to the knee.  Current thinking in knee surgery is that abnormal motion of the knee joint can cause tears of the menisci (disks of cartilage) and possibly early arthritis in the knee.  The ACL is an important ligament in controlling stability of the knee.

Results:

A total of 1,960 patients in whom Dr. Cross performed a reconstruction of the Anterior Cruciate Ligament (ACL) were reviewed.  The average age of the patients at the time of surgery was 28 years.  There were 74% males and 26% females in this group.  The time from injury to repair varied from under one week to 51 years.

Patients with internal damage to the knee (damage to the menisci or joint lining) were noted to have had reconstructions performed an average of 3.9 years after injury, while those without joint damage had surgery performed much earlier (1.5 years).  We also noted a progressive increase in the percentage of patients with additional joint damage as time increased from injury to reconstruction.

Discussion:

The ACL is an important structure in controlling stability of the knee.  Damage to the cartilage of the joint (both the joint lining as well as the cartilage disks, or menisci) can occur in combination with this injury.  Sometimes damage can be done at the time of the injury that tears the ACL.  Our study indicates that additional damage can occur over time.  Episodes of instability or "giving way" of the knee can pinch and tear the cartilage disks (menisci).  The abnormal motion of the joint can also cause increased wear to the joint lining (chondral surface).  Both of these situations can lead to pain and early joint arthritis.

Conclusion:

From this study we feel that patients with knee instability from ACL injuries would benefit from early rather than late surgical reconstruction.  This would hopefully decrease the amount of additional damage that the joint would suffer.  Other medical studies have also shown this increase in damage done by continued instability.

Not all people with ACL injuries have problems with instability.  As we only looked at patients who eventually had surgery due to ongoing problems, we can not make comments regarding people who have a torn ACL but are not symptomatic.

In general, we would recommend ACL reconstruction to anyone who plans to return to playing sport, particularly sports that involve "cutting" or side to side motion and jumping.  Even patients who do not plan to engage in sport should have surgery if they have episodes of instability or "giving way" in the knee.  These episodes not only are painful and limit activities, but can result in damage to the knee joint with a risk of future problems and possibly arthritis.

 

  Delayed Anterior Cruciate Ligament Repair

 

 

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