Delaying ACL reconstruction beyond 6 months from injury impacts likelihood for clinically significant outcome improvement |
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| Institution: | 1. Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA;2. Dept. of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA;3. Dept. of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY, USA;4. School of Medicine, Vagelos Columbia College of Physicians and Surgeons, New York, NY, USA;5. Dept. of Orthopaedic Surgery, University of Illinois - Chicago, Chicago, IL, USA;6. Dept. of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA;1. Anatomy Laboratory, Faculty of Medicine, University of Thessaly, Larissa, Greece;2. Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece;3. Laboratory of Mechanics and Strength of Materials, Department of Mechanical Engineering, University of Thessaly Volos, Volos, Greece;4. Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA;1. Graduate School of Health Sciences, Morinomiya University of Medical Sciences, Osaka, Japan;2. Department of rehabilition, Yamamuro Clinic, Toyama, Japan;3. Musculoskeletal Intervention Center, Okuno Clinic, Tokyo, Japan;4. Inclusive Medical Science Research Institute, Morinomiya University of Medical Sciences, Osaka, Japan;5. AR-Ex medical research center, Tokyo, Japan;1. Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung, Augsburg, Germany;2. Institute for Upright MRI Munich, Aschheim/Munich, Germany;3. Clinic and Policlinic for Orthopedic Surgery, University Rostock, Rostock, Germany;4. Department for Orthopedic Surgery, Schoen Klinik Munich Harlaching, Munich, Germany;5. Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Technical University Munich, Klinikum Rechts der Isar, Munich, Germany;1. Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan;2. Department of Orthopaedic Surgery, University of Michigan, MI, USA;3. Deparment of Orthopaedic Surgery, Saiseikai Niigata Hospital, Niigata, Japan;4. Center for Fostering Innovative Leadership, Institute for Research Collaboration and Promotion, Niigata University, Niigata, Japan;1. Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, United States;2. Spaarne Gasthuis Hospital, Department of Orthopaedic Surgery, Hoofddorp, the Netherlands;3. Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Department of Orthopaedic Surgery, Amsterdam, the Netherlands |
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| Abstract: | BackgroundThe effect of surgical latency on outcomes of anterior cruciate ligament reconstruction (ACLR) is a topic that is heavily debated. Some studies report increased benefit when time from injury to surgery is decreased while other studies report no benefit. The purpose of our analysis was to compare achievement of clinically significant outcomes (CSOs) in patients with greater than six months of time from injury to ACLR to those with less than or equal to six months of time to surgery.MethodsPatients undergoing primary ACLR between January 2017 and January 2018 with minimum one year follow-up were included. International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcomes Score (KOOS) were collected. Multivariate logistic regression was performed for outcome achievement and risk of revision ACLR and Weibull parametric survival analysis was performed for relative time to outcome achievement. The level of significance was set at α = 0.05.Results379 patients were included of which, 140 patients sustained ACL injury greater than six months prior to surgery. This group of patients experienced reduced likelihood to achieve patient-acceptable symptomatic state (PASS) on the IKDC (p = 0.03), KOOS Pain (p = 0.01) and a greater likelihood to undergo revision ACLR (p = 0.001). There was no impact of surgical timing on minimal clinically important difference (MCID).ConclusionPatients with greater than 6 months from injury to ACLR reported reduced likelihood to achieve CSOs, delayed achievement of CSOs, and increased rates of revision surgery. |
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| Keywords: | ACL Anterior cruciate ligament Clinically significant outcomes Patient reported outcome measures Anterior cruciate ligament reconstruction |
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