Riepen Dietrich, Kanski Gregory, Chavez Audrie Aliza, Tavakolian Paul, Gronbeck Christian, Khazzam Michael, Coyner Katherine J
University of Texas Southwestern Medical Center, Dallas, Texas, USA.
UConn Health, Farmington, Connecticut, USA.
Orthop J Sports Med. 2022 Mar 31;10(3):23259671211073905. doi: 10.1177/23259671211073905. eCollection 2022 Mar.
Delays from the time of an anterior cruciate ligament (ACL) tear to surgical reconstruction are associated with an increased incidence of meniscal and chondral injuries.
To evaluate the association between delays in ACL reconstruction (ACLR) and risk factors for intra-articular injuries across 8 patient demographic subsets.
Cross-sectional study; Level of evidence, 3.
We performed a retrospective chart review of all patients who underwent ACLR from January 2009 to May 2015 at a single institution. Variables collected were age, sex, body mass index, time from injury to surgery, and presence of meniscal tears and chondral injuries. Demographic subsets were created according to sex, age (<27 vs ≥27 years), body mass index (<25 vs ≥25 kg/m), and injury setting (sports vs non-sports related). Subsets were divided by time from injury to ACLR: 0 to <6 months (control group), 6 to <12 months, and ≥12 months. Multivariate logistic regression-generated odds ratios (ORs) were calculated.
Overall, 410 patients were included. ORs were significant for an increased incidence of medial meniscal tears (MMTs) (OR, 1.12-3.72; = .02), medial femoral condyle (MFC) injuries (OR, 1.18-4.81; = .02), and medial tibial plateau (MTP) injuries (OR, 1.33-31.07; = .02) with surgical delays of 6 to <12 months. With ≥12-month delays, significance was found for MMTs (OR, 2.92-8.64; < .001), MFC injuries (OR, 1.86-5.88; < .001), MTP injuries (OR, 1.37-21.22; = .02), lateral femoral condyle injuries (OR, 2.41-14.94; < .001), and lateral tibial plateau injuries (OR, 1.15-5.27; = .02). In the subset analysis, differences in the timing, location, rate, and pattern of chondral and meniscal injuries became evident. Female patients and patients with non-sports-related ACL tears had less risk of associated injuries with delayed surgery, while other demographic groups showed an increased injury risk.
When analyzing patients who were symptomatic enough to eventually require surgery, an increased incidence of MMTs and medial chondral injuries was associated with ≥6-month delays in ACLR, and an increased incidence of lateral chondral injuries was associated with ≥12-month delays. Female patients and patients with non-sports-related ACL tears had less risk of injuries with delayed ACLR.
从前交叉韧带（ACL）撕裂至手术重建的延迟与半月板和软骨损伤的发生率增加相关。
评估ACL重建（ACLR）延迟与8个人口统计学亚组关节内损伤危险因素之间的关联。
横断面研究；证据等级，3级。
我们对2009年1月至2015年5月在单一机构接受ACLR的所有患者进行了回顾性病历审查。收集的变量包括年龄、性别、体重指数、受伤至手术的时间，以及半月板撕裂和软骨损伤的情况。根据性别、年龄（<27岁与≥27岁）、体重指数（<25kg/m²与≥25kg/m²）和损伤情况（运动相关与非运动相关）创建人口统计学亚组。亚组按受伤至ACLR的时间分为：0至<6个月（对照组）、6至<12个月和≥12个月。计算多变量逻辑回归生成的比值比（OR）。
总体而言，纳入了410例患者。手术延迟6至<12个月时，内侧半月板撕裂（MMT）（OR，1.12 - 3.72；P = 0.02）、股骨内侧髁（MFC）损伤（OR，1.18 - 4.81；P = 0.02）和胫骨内侧平台（MTP）损伤（OR，1.33 - 31.07；P = 0.02）的发生率显著增加。延迟≥12个月时，MMT（OR，2.92 - 8.64；P < 0.001）、MFC损伤（OR，1.86 - 5.88；P < 0.001）、MTP损伤（OR，1.37 - 21.22；P = 0.02）、股骨外侧髁损伤（OR，2.41 - 14.94；P < 0.001）和胫骨外侧平台损伤（OR，1.15 - 5.27；P = 0.02）具有显著意义。在亚组分析中，软骨和半月板损伤的时间、位置、发生率和模式差异变得明显。女性患者和非运动相关ACL撕裂的患者延迟手术时相关损伤的风险较低，而其他人口统计学组显示损伤风险增加。
在分析有症状最终需要手术的患者时，MMT和内侧软骨损伤的发生率增加与ACLR延迟≥6个月相关，外侧软骨损伤的发生率增加与延迟≥12个月相关。女性患者和非运动相关ACL撕裂的患者ACLR延迟时受伤风险较低。
