When should an anterior cruciate ligament (ACL) tear have surgery?
How long can ACL surgery be delayed?
Rupture of the anterior cruciate ligament (ACL) of the knee is a common injury in sports patients. The consequence will be antero-posterior and rotational instability of the knee. Patients present with a sense of failure and inability to return to their sporting activities1.
In a knee with an insufficient ACL the internal meniscus takes on an anterior-posterior stabilising role, with the posterior horn being called upon. Thus, in chronic anterior cruciate ligament injuries, secondary tears of the internal meniscus, typically longitudinal-vertical tears that progress to bucket-handle tears, are common2.
Delayed time to ligament reconstruction surgery poses a risk of secondary meniscal tears.
Delaying treatment in patients with frank instability increases the risk of meniscal and articular cartilage injury, and the monthly relative risk of developing a meniscal tear during the wait for ligament surgery can be established. These secondary injuries have a greater impact on long-term prognosis and arthritic degeneration of the knee than the ACL tear itself3-5.
Surgical reconstruction of the ACL achieves good results in a very high percentage of cases, restoring knee stability and allowing patients to return to their sporting activities after appropriate recovery and rehabilitation time.
During ACL surgery, it is necessary to try to preserve the meniscus to avoid subsequent arthritic degeneration. Lesions that are initially easily repairable with meniscal suture preservation may progress to more severe, non-repairable tears that require meniscectomy (removal of the meniscus)6.
Meniscal repair techniques associated with ACL ligamentoplasty have a very good prognosis with very high healing rates7.
Delayed surgical treatment of patients with symptomatic ACL tears increases the risk of associated injuries, long-term prognosis and osteoarthritic degeneration. Early surgery increases the rate of meniscal preservation which may protect the knee from long-term osteoarthritis.
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- García-Germán D, Delgado A, Hernández J. LESIONES DE LOS LIGAMENTOS Y MENISCOS DE LA RODILLA. Cirugía Ortopédica y Traumatología, 2º Edición, 2012. Ed. Alberto Delgado Martínez. Panamericana. ISBN: 978-8498352108
- García-Germán D, DESTINO DEL MENISCO INTERNO EN UNA LESIÓN CRÓNICA DEL LCA. Libro de Casos en Cirugía Ortopédica y Traumatología nº 10, 2011. Luzán 5, S.A. de Ediciones.. ISBN: 978-84-7989-690-4.
- De Roeck NJ, Lang-Stevenson A. Meniscal tears sustained awaiting anterior cruciate ligament reconstruction. Injury. 2003;34:343-5.
- Tayton E, Verma R, Higgins B, Gosal H. A correlation of time with meniscal tears in anterior cruciate ligament deficiency: stratifying the risk of surgical delay. Knee Surg Sports Traumatol Arthrosc. 2009;17:30-4.
- Yoo JC, Ahn JH, Lee SH, Yoon YC. Increasing incidence of medial meniscal tears in nonoperatively treated anterior cruciate ligament insufficiency patients documented by serial magnetic resonance imaging studies. Am J Sports Med 2009;37:1478-83.
- Lubowitz JH, Poeling GG. Save the meniscus. Arthroscopy. 2011;27:301-2
- Toman CV, Dunn WR, Spindler KP, et al. Success of meniscal repair at anterior cruciate ligament reconstruction. Am J Sports Med. 2009;37:1111-5
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