title: Delay in surgery predisposes to meniscal and chondral injuries in anterior cruciate ligament deficient knees.
abstract: BACKGROUND
  Despite improvements in instability after anterior cruciate ligament (ACL) reconstruction, associated intraarticular injuries remain a major cause of concern and important prognostic factor for long term results as it may lead to osteoarthritis. Delay in ACL reconstruction has been in variably linked to increase in these injuries but there is lack of consensus regarding optimal timing of reconstruction. The goal of this study was to investigate delay in surgery and other factors, associated with intraarticular injuries in ACL deficient knees.
  
  
  METHODS
  A total of 438 patients (42 females; 396 males) enrolled for this prospective observational study. The average age of patients was 26.43 (range 17-51 years) years with a mean surgical delay of 78.91 (range 1 week - 18 years) weeks after injury. We analyzed the factors of age, sex, surgical delay, instability, and level of activity for possible association with intraarticular injuries.
  
  
  RESULTS
  Medial meniscus injuries had a significant association with surgical delay (P= 0.000) after a delay of 6 months. Lateral meniscus injuries had a significant association with degree of instability (P= 0.001). Medial-sided articular injuries were significantly affected by age (0.005) with an odds ratio (OR) of 1.048 (95% confidence interval [CI] of 1.014-1.082) reflecting 4.8% rise in incidence with each year. Lateral-sided injuries were associated with female sex (P= 0.018) with OR of 2.846 (95% CI of 1.200-6.752). The level of activity failed to reveal any significant associations.
  
  
  CONCLUSIONS
  Surgical delay predicts an increase in medial meniscal and lateral articular injuries justifying early rather than delayed reconstruction in ACL deficient knees. Increasing age is positively related to intraarticular injuries while females are more susceptible to lateral articular injuries.
authors.affiliation: Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Ravi
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Gladson David
authors.initials: GD
authors.lastname: Masih
authors.affiliation: Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Chander
authors.affiliation: Department of Orthopaedics, Government Medical College and Hospital, Chandigarh, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Bachhal
keywords: Anterior cruciate ligament; Sports medicine; anterior cruciate ligament; anterior cruciate ligament tear; cartilage; chondral damage; knee; knee joint; meniscal injuries; osteoarthritis