Anterior Cruciate Ligament Reconstruction Surgery Timing with Respect to Meniscal‑Chondral Damage

Document Type : Original Article


Department of Orthopedics, Taleghani Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran



Background: Anterior cruciate ligament (ACL) tear is one of the most common types of knee injuries. Delay in diagnosis and treatment of ACL
injuries can lead to further damage of the meniscus and cartilage. In this study, we tried to show the distribution of injuries over time and types.
Methods: This retrospective study was performed on 336 patients with the diagnosis of primary ACL tear without other ligament injuries. The
data including site and grade of the meniscal tear and cartilage damage, based on the International Cartilage Repair Society Classification, the
time between diagnosis and surgical procedure, and the treatment method were collected. In this study, we divided patients into four groups
according to injury to surgery time. Groups were 3 months, 3–6 months, 6–12 months, and over 12 months to surgery. Results: The results
showed that a rate of cartilage damage had no significant correlation with a time interval between injury and surgery (P = 0.54). Furthermore,
no significant correlation was found between the site of cartilage damage and the interval time after injury to surgery. The results indicated that
the meniscal tear increases in case of a delay to perform surgery (P = 0.004). However, no significant relation was found between the site and
pattern of meniscal injury and time. Moreover, patients with a complete ACL tear had a significantly higher rate of meniscus injury compared
to those with a partial ACL tear (0.048). Conclusion: The findings of this study show that there is no significant relationship between the
time of surgery and the risk of chondral damage after the ACL tear over time. ACL‑ruptured patients should undergo the ACL reconstruction
surgery up to 3 months from knee trauma to prevent further meniscal injuries.


1. Moses B, Orchard J, Orchard J. Systematic review: Annual incidence of ACL injury and surgery in various populations. Res Sports Med 2012;20:157‑79.
2. Junge A, Rösch D, Peterson L, Graf‑Baumann T, Dvorak J. Prevention of soccer injuries: A prospective intervention study in youth amateur players. Am J Sports Med 2002;30:652‑9.
3. Andersson C, Odensten M, Good L, Gillquist J. Surgical or non‑surgical treatment of acute rupture of the anterior cruciate ligament. Arandomized study with long‑term follow‑up. J Bone Joint Surg Am 1989;71:965‑74.
4. Buss DD, Min R, Skyhar M, Galinat B, Warren RF, Wickiewicz TL, et al. Nonoperative treatment of acute anterior cruciate ligament injuries in a selected group of patients. Am J Sports Med 1995;23:160‑5.
5. Fitzgerald GK, Axe MJ, Snyder‑Mackler L. A decision‑making scheme for returning patients to high‑level activity with nonoperative treatment after anterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc 2000;8:76‑82.
6. Bedi A, Chen T, Santner TJ, El‑Amin S, Kelly NH, Warren RF, et al. Changes in dynamic medial tibiofemoral contact mechanics and kinematics after injury of the anterior cruciate ligament: A cadaveric model. Proc Inst Mech Eng H 2013;227:1027‑37.
7. Boeth H, Duda GN, Heller MO, Ehrig RM, Doyscher R, Jung T, et al. Anterior cruciate ligament‑deficient patients with passive knee joint laxity have a decreased range of anterior‑posterior motion during active movements. Am J Sports Med 2013;41:1051‑7.
8. Lee SJ, Aadalen KJ, Malaviya P, Lorenz EP, Hayden JK, Farr J, et al. Tibiofemoral contact mechanics after serial medial meniscectomies in the human cadaveric knee. Am J Sports Med 2006;34:1334‑44.
9. Murrell GA, Maddali S, Horovitz L, Oakley SP, Warren RF. The effects of time course after anterior cruciate ligament injury in correlation with meniscal and cartilage loss. Am J Sports Med 2001;29:9‑14.
10. Papageorgiou CD, Gil JE, Kanamori A, Fenwick JA, Woo SL, Fu FH, et al. The biomechanical interdependence between the anterior cruciate ligament replacement graft and the medial meniscus. Am J Sports Med 2001;29:226‑31.
11. Granan LP, Bahr R, Lie SA, Engebretsen L. Timing of anterior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: A cohort study based on the Norwegian National Knee Ligament Registry. Am J Sports Med 2009;37:955‑61.
12. Brittberg M, Winalski CS. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 2003;85‑A Suppl 2:58‑69.
13. GuptaR, Masih GD, Chander G, BachhalV. Delay in surgery predisposes to meniscal and chondral injuries in anterior cruciate ligament deficient knees. Indian J Orthop 2016;50:492‑8.
14. Coyner KJ, Chavez AA, Riepen DW, Schell B, Khazzam MS. Anterior Cruciate Ligament Tears: Impact of Delayed Presentation on IntraArticular Injuries. Orthopaedic Journal of Sports Medicine 2017;5 (7_suppl6).
15. de Campos GC, Nery Jr W, Teixeira PE, Araujo PH, Alves Jr WD. Association between meniscal and chondral lesions and timing of anterior cruciate ligament reconstruction. Orthopaedic journal of sports medicine 2016;4.
16. Noyes FR, Mooar PA, Matthews DS, Butler DL. The symptomatic anterior cruciate‑deficient knee. Part I: The long‑term functional disability in athletically active individuals. J Bone Joint Surg Am 1983;65:154‑62.
17. Millett PJ, Willis AA, Warren RF. Associated injuries in pediatric and adolescent anterior cruciate ligament tears: Does a delay in treatment increase the risk of meniscal tear? Arthroscopy 2002;18:955‑9.
18. Hagino T, Ochiai S, Senga S, Yamashita T, Wako M, Ando T, et al. Meniscal tears associated with anterior cruciate ligament injury. Arch Orthop Trauma Surg 2015;135:1701‑6.
19. Brambilla L, Pulici L, Carimati G, Quaglia A, Prospero E, Bait C, et al. Prevalence of associated lesions in anterior cruciate ligament reconstruction: Correlation with surgical timing and with patient age, sex, and body mass index. Am J Sports Med 2015;43:2966‑73.