title: Timing of anterior cruciate ligament reconstruction within the first year after trauma and its influence on treatment of cartilage and meniscus pathology.
abstract: OBJECTIVE
  Anterior cruciate ligament (ACL) ruptures are often associated with primary meniscal and cartilage lesions. Late reconstruction of ACL-deficient knees may increase the risk of developing secondary meniscal and cartilage lesions; hence, the timing of ACL repair is of the utmost importance. Because meniscus outcome is also a potential predictor for osteoarthritis (OA), this study compared ACL repair within the first 6 months after injury to that of surgery conducted 7-12 months after injury with regard to the incidence of meniscal and cartilage lesions.
  
  
  METHODS
  This prospective cross-sectional study included all complete isolated primary ACL ruptures treated in our institution within 1 year after trauma over a 12-month period. Exclusion criteria were revision ACL, complex ligament injuries, previous knee surgery, and missing injury data. Cartilage lesions were classified according to the score established by the International Cartilage Repair Society (ICRS score) and meniscal tears according to their treatment options.
  
  
  RESULTS
  Two hundred and thirty-three of 730 patients (162 men, 71 women) with ACL repair met the inclusion criteria. 86.3 % of surgical interventions were conducted within 6 months and 13.7 % after 6 months of trauma. Severe cartilage lesions grade III-IV did not significantly differ between the different time points of ACL repair (<6 months 39.9 %; >6 months 31.3 %; p = n.s.). Medial meniscus lesions received significantly higher meniscal repair in early compared to delayed ACL repair. Significantly higher rate of meniscal repair of the medial meniscus was seen in cases of early ACL repair compared to delayed (<6 months 77.2 %, >6 months 46.7; p = 0.022). The rate of medial meniscal repair in early ACL repair was significantly higher for women (89.5-0 %; p = 0.002), however, not for men (73.3-53.8 %; p = n.s.). No differences were found for lateral meniscal lesions, with regard to neither the different time points (p = n.s.) nor the sex (p = n.s.).
  
  
  CONCLUSIONS
  Because of the significantly higher rate of prognostically advantageous meniscal repair, the recommendation for an ACL reconstruction within 6 months after trauma was made to preserve the meniscus and reduce the risk of developing OA.
  
  
  METHODS
  Prospective cross-sectional cohort study, Level II.
authors.affiliation: Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany. werner.krutsch@ukr.de.
authors.forename: Werner
authors.initials: W
authors.lastname: Krutsch
authors.affiliation: Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Zellner
authors.affiliation: Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Baumann
authors.affiliation: Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Pfeifer
authors.affiliation: Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Nerlich
authors.affiliation: Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.|Sporthopaedicum, Straubing/Regensburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Angele
mesh_terms: D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction; D002357:Cartilage Diseases / Q000473:pathology* / Q000601:surgery; D002358:Cartilage, Articular / Q000601:surgery; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007593:Joint Instability / Q000601:surgery; D008297:Male; D008592:Menisci, Tibial / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery; D011446:Prospective Studies; D000070600:Tibial Meniscus Injuries / Q000601:surgery; D013997:Time Factors; D055815:Young Adult
keywords: ACL repair; ACL rupture; Cartilage lesion; Meniscus repair; Osteoarthritis