Chronicity of Anterior Cruciate Ligament Injury Does Not Adversely Affect the Clinical Outcomes of Primary Repair in Appropriately Selected Patients.

Abstract

To determine the association between surgical delay, anterior cruciate ligament (ACL) tissue quality, failure rates, and clinical outcomes at a minimum 2-year follow-up after arthroscopic ACL primary repair (ACLPR). Consecutive patients with complete, proximal (type I/II) ACL tears who underwent arthroscopic ACLPR and had a minimum 2-year follow-up were included. Surgical delay was stratified into 3 categories: acute (≤21 days), subacute (22-90 days), and chronic (>90 days). Intraoperative tissue quality was assessed according to synovial sheath integrity (grade 1, completely intact; grade 2, >50% intact; grade 3, <50% intact) and rupture pattern (1-bundle, 2-bundle, and complex tear). Failure was defined as instrumented laxity >3 mm anterior tibial translation side-to-side difference, pivot shift grade ≥2, and/or subjective instability. Clinical and patient-reported outcomes were compared and Patient Acceptable Symptom State thresholds established. Between 2008 and 2021, 276 of 298 (loss to follow-up, 7.4%) patients (mean age, 39.7 ± 10.7 years; females, 50.3%) who underwent ACLPR with a follow-up of 2.9 ± 1.0 years (2.0-6.5 years) met the inclusion criteria. Sixty-eight (24.6%) ACLPR were acute, 152 (50.1%) subacute, and 56 (20.3%) chronic. Surgical delay was not significantly correlated with worse tissue quality (grade 2, P = .79; grade 3, P = .06) or increased failure risk (P = .57). ACLPR failure occurred in 28 patients (10.1%), with no significant differences among groups (acute, 10.2%; subacute, 11.2%; chronic, 7.1%; P = .76). Reoperation rates (P = .62) and anterior tibial translation side-to-side difference (P = .90), as well as patient-reported outcomes (all P > .28) and Patient Acceptable Symptom State threshold achievements (overall: International Knee Documentation Committee, 84.7%; Lysholm, 83.3%; Forgotten Joint Score-12, 87.3%; and ACL-Return to Sport after Injury, 88.5%) were comparable across groups (all P > .05). Injury chronicity did not adversely affect failure rates or clinical outcomes at minimum 2-year follow-up after ACLPR. Therefore, in the case of a proximal tear location and sufficient tissue quality, surgical delay alone should not be considered a contraindication for ACLPR. Level III, retrospective comparative case series.