Brian Forsythe1, Yining Lu2, Avinesh Agarwalla3, Chimere O Ezuma4, Bhavik H Patel5, Benedict U Nwachukwu6, Alexander Beletsky7, Jorge Chahla7, Craig R Kym5, Adam B Yanke7, Brian J Cole7, Charles A Bush-Joseph7, Bernard R Bach7, Nikhil N Verma7. 1. Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA. Electronic address: forsythe.research@rushortho.com. 2. Dept. of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA. 3. Dept. of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY, USA. 4. School of Medicine, Vagelos Columbia College of Physicians and Surgeons, New York, NY, USA. 5. Dept. of Orthopaedic Surgery, University of Illinois - Chicago, Chicago, IL, USA. 6. Dept. of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. 7. Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
Abstract
BACKGROUND: The effect of surgical latency on outcomes of anterior cruciate ligament reconstruction (ACLR) is a topic that is heavily debated. Some studies report increased benefit when time from injury to surgery is decreased while other studies report no benefit. The purpose of our analysis was to compare achievement of clinically significant outcomes (CSOs) in patients with greater than six months of time from injury to ACLR to those with less than or equal to six months of time to surgery. METHODS: Patients undergoing primary ACLR between January 2017 and January 2018 with minimum one year follow-up were included. International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcomes Score (KOOS) were collected. Multivariate logistic regression was performed for outcome achievement and risk of revision ACLR and Weibull parametric survival analysis was performed for relative time to outcome achievement. The level of significance was set at α = 0.05. RESULTS: 379 patients were included of which, 140 patients sustained ACL injury greater than six months prior to surgery. This group of patients experienced reduced likelihood to achieve patient-acceptable symptomatic state (PASS) on the IKDC (p = 0.03), KOOS Pain (p = 0.01) and a greater likelihood to undergo revision ACLR (p = 0.001). There was no impact of surgical timing on minimal clinically important difference (MCID). CONCLUSION: Patients with greater than 6 months from injury to ACLR reported reduced likelihood to achieve CSOs, delayed achievement of CSOs, and increased rates of revision surgery.
BACKGROUND: The effect of surgical latency on outcomes of anterior cruciate ligament reconstruction (ACLR) is a topic that is heavily debated. Some studies report increased benefit when time from injury to surgery is decreased while other studies report no benefit. The purpose of our analysis was to compare achievement of clinically significant outcomes (CSOs) in patients with greater than six months of time from injury to ACLR to those with less than or equal to six months of time to surgery. METHODS: Patients undergoing primary ACLR between January 2017 and January 2018 with minimum one year follow-up were included. International Knee Documentation Committee (IKDC) score and Knee Injury and Osteoarthritis Outcomes Score (KOOS) were collected. Multivariate logistic regression was performed for outcome achievement and risk of revision ACLR and Weibull parametric survival analysis was performed for relative time to outcome achievement. The level of significance was set at α = 0.05. RESULTS: 379 patients were included of which, 140 patients sustained ACL injury greater than six months prior to surgery. This group of patients experienced reduced likelihood to achieve patient-acceptable symptomatic state (PASS) on the IKDC (p = 0.03), KOOS Pain (p = 0.01) and a greater likelihood to undergo revision ACLR (p = 0.001). There was no impact of surgical timing on minimal clinically important difference (MCID). CONCLUSION: Patients with greater than 6 months from injury to ACLR reported reduced likelihood to achieve CSOs, delayed achievement of CSOs, and increased rates of revision surgery.
Authors: Siddharth Sripada; Harrison Loader; Man Hei Marcus Kam; Arslan Khaliq Raja; Joshua Haggart; Thomas Fawcett; Cameron Peattie; Samuel Molyneux; Nicholas Clement Journal: Adv Orthop Date: 2022-06-24
Authors: David Y Ding; Richard N Chang; Sachin Allahabadi; Monica J Coughlan; Heather A Prentice; Gregory B Maletis Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-02-24 Impact factor: 4.114