Delays in ACL Reconstruction are Associated with Higher Rates of Meniscus and Chondral Pathology in Skeletally Immature Patients

BACKGROUND: ACL reconstruction timing remains controversial with some studies favoring early reconstruction within 60 to 90 days of injury to lessen the probability of chondral and meniscus pathology. HYPOTHESIS/PURPOSE: To prospectively evaluate skeletally immature patients with ACL tears to assess the correlation between meniscus and chondral pathology and delays in surgical treatment, and to determine if surgical delays lead to higher rates of meniscus debridement and a higher need for cartilage treatment. METHODS: A consecutive series of skeletally immature patients diagnosed with ACL tears between 2016 and 2020 from 10 geographically diverse institutions were enrolled. Univariable and multivariable logistic regression analysis was performed to determine the association between time from injury to surgery and the likelihood of meniscal or chondral injury. RESULTS: Analysis included 747 patients, and 56.6% had a meniscus tear. Tears were more likely to occur in older patients (chronologic age 12.6 versus 12.0; p≤0.001). Patients with a bone age greater than 13 years were 2 times more likely to have a meniscus tear (OR=2.0; p≤0.001). No association was detected between continuous time to surgery and likelihood of a meniscus tear. However, patients who had surgery greater than 60 days from injury were 1.5 times more likely to have a meniscal tear (OR=1.54; p=0.006). The lateral and medial meniscus were repaired 68% and 90% of the time, respectively. There was no association between time from injury to surgery and the likelihood of repair. Sixty-five chondral injuries in 48 patients were identified. Patients who had surgery more than 90 days from injury were 3 times more likely to have a chondral injury (OR=3.3; p≤;0.001). Furthermore, patients with a bone age greater than 13 years had 7 times the odds of chondral injury (OR=6.8; p=0.002) compared to younger patients. Nineteen of 48 patients (40%) with chondral injury required treatment, but there was no association between time from injury to surgery and the need for treatment (p=0.55). CONCLUSION: A synergistic effect between patient age and delay in surgery was observed such that older patients and those with longer delays to surgery were more likely to have meniscus and chondral pathology at the time of ACL reconstruction. This data suggests that older adolescent patients may benefit from earlier surgical intervention, but it is unclear whether earlier surgery will alter the rates of long-term osteoarthritis.