Delayed primary isolated posterior cruciate ligament reconstruction is not associated with intraarticular injury prevalence: A study from the Scandinavian Knee Ligament Registries.

Abstract

Biomechanical studies suggest that persistent posterior cruciate ligament (PCL) deficiency may lead to abnormal joint contact mechanics and subsequent secondary intraarticular injury. However, clinical evidence that delayed PCL reconstruction (PCL-R) directly impacts the prevalence of intraarticular injury remains limited. The aim of the study was to determine the impact of time from injury to surgery on the prevalence of intraarticular injury in patients with primary isolated PCL-R. Patients with PCL-R registered in the Scandinavian Knee Ligament Registries between 2004 and 2020 were considered for eligibility. Patients with primary isolated PCL-R and complete preoperative baseline Knee injury and Osteoarthritis Outcome Score (KOOS) were selected for the final study population. The primary outcome was the prevalence of intraarticular injury at the time of PCL-R, defined as meniscal tear or articular cartilage injury of any grade determined during diagnostic arthroscopic examination. Univariable logistic regression was used to determine the association between time from injury to primary isolated PCL-R and intraarticular injury prevalence, overall and by knee compartment. A total of 210 patients were included (mean age 29.7 ± 11.8 years, 61% male). The median time from injury to surgery was 14.2 months (range: 0.4-128.8 months). The mean baseline KOOS knee-related quality of life (QoL) subscale was 31.2 (95% confidence interval [CI] = 28.9-33.6). Overall, 105 (50%) patients had intraarticular injuries at the time of PCL-R. Univariable logistic regression showed no statistically significant association between time from injury to PCL-R and overall intraarticular injury prevalence (odds ratio = 1.01; 95% CI, 1.01-1.02; p = 0.19). Similarly, no significant associations were found between surgical timing and injury across specific knee compartments. Delayed surgical timing is not associated with an increased prevalence of intraarticular knee injury in patients with primary isolated PCL-R. Consequently, registry data do not corroborate the hypothesized relationship between persistent knee instability and intraarticular injury burden in patients with PCL deficiency. Retrospective cohort study, level III.