SAN FRANCISCO — Meniscus injury in patients undergoing anterior cruciate ligament reconstruction was three times more likely to be repairable when the repair was done within 12 weeks of the injury, based on the results of a retrospective study.
The findings corroborate those of several previous studies that linked increased meniscus pathology with longer wait times from injury to ACL reconstruction, Jason Akindolire said at the annual meeting of the American Academy of Orthopaedic Surgeons.
Mr. Akindolire and his associates reviewed the records of 317 consecutive patients, aged 40 years or younger, who underwent ACL reconstructions in 2003–2005 at two clinics—one operating in the Canadian national system of guaranteed health care, where wait times can be longer than those in the United States, and the other a private clinic in Mississippi, where many of the fees for service are paid by third-party payers.
Patient demographics were similar, with a mean age of 23 years in Canada and 22 years in Mississippi. Practice patterns at the clinics were similar. The study excluded patients who had multiligament injuries or a history of ipsilateral surgery.
Mean wait times from injury to ACL reconstruction were 76 weeks (median 40 weeks) in the Canadian clinic and 23 weeks (median 4.4 weeks) in the U.S. clinic, reported Mr. Akindolire, a graduate student in sports medicine at the University of Western Ontario, London.
Among patients with meniscus pathology, those at the U.S. clinic were 78% more likely to have a repairable tear, compared with patients at the Canadian clinic.
Meniscus tears were less amenable to repair as the time to ACL reconstruction increased, he said. The odds of meniscal pathology being repairable were 2.6 for patients who underwent ACL reconstruction less than 12 weeks after injury, compared with those who had later surgery, and were 1.7 for patients who underwent ACL reconstruction less than 26 weeks after injury, compared with those who had surgery later.
As the time between injury and ACL reconstruction increased, the complexity of meniscus tears also increased, Mr. Akindolire added. Over time, more bucket-handle tears and complex degenerative tears were seen in his review of intraoperative diagrams and notes.
“There is merit to providing expeditious ACL reconstruction—within 12 weeks, perhaps,” he said. “By doing that, we may be able to preserve the menisci. And in doing that, hopefully, we will improve the long-term prognosis of these patients.”
A separate retrospective study by other investigators in 2004 reported that patients who wait 2 or more years for ACL reconstruction are nearly twice as likely to develop immediate meniscal pathology, compared with patients whose ACL was treated within 1 year, he noted.
Another retrospective study in 2005 reported that patients who waited 26 weeks or more for ACL reconstruction had a significantly greater risk of developing meniscal pathology, compared with patients who underwent ACL surgery within 2 weeks of injury.
Separate data have shown that “a meniscus tear is a strong independent predictor for the development of osteoarthritis,” Mr. Akindolire said.