Giving-way episodes during preoperative waiting period increase associated injury in anterior cruciate ligament injury: A multicentre observational study.

Abstract

This study aimed to investigate the impact of giving-way episodes (GWEs) during the preoperative waiting period on intra-articular associated injuries in patients with anterior cruciate ligament (ACL) injuries. This multicentre retrospective cohort study reviewed consecutive patients who underwent primary ACL reconstruction between October 2022 and August 2024. Patients were divided into two groups based on GWE frequency during the waiting period: Group A (one giving-way episode) and Group B (two or more giving-way episodes). Data collected included demographic data, preoperative waiting time, preoperative knee instability (Lachman and pivot shift tests), and arthroscopically confirmed meniscal and cartilage injuries. Univariate analyses were used to compare intra-articular injury incidence between groups, followed by multivariate logistic regression to identify independent risk factors for medial meniscus (MM) tears. Covariates included age, sex, body mass index, GWE frequency, preoperative waiting time, instability grades, and activity level. Of the 239 enrolled patients, 136 and 103 were assigned to Groups A and B, respectively. Patient demographics (age, sex and BMI) showed no significant differences between the two groups. The mean preoperative waiting time was significantly longer in Group B (5.0 vs. 2.0 months, p < 0.001). Additionally, Group B showed a significantly higher incidence of MM tears compared to Group A (48.5% vs. 24.3%, p < 0.001). No significant differences were observed in lateral meniscus tears or cartilage damage. Multivariate analysis identified ≥2 GWEs (odds ratio (OR): 3.09, 95% confidence interval (CI): 1.64-5.84) and higher pivot shift grade (OR: 1.92, 95% CI: 1.02-3.62) as independent predictors of MM tears. Experiencing two or more GWEs during the preoperative waiting period independently triples the risk of MM tears. Preventing GWEs before ACL reconstruction may be critical to minimising secondary intra-articular damage. Level II, prognostic studies.