The correlation between chondral lesions and the chronicity of anterior cruciate ligament tear

Introduction:
Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures in orthopedic surgery but no clear guideline regarding the timing of reconstruction has been established. It is assumed that the delay in ACL reconstruction may predispose the patient to cartilage destruction. The purpose of this study was to determine the association between chondral lesions and the chronicity of ACL tear and to estimate the best timing of ACL reconstruction following injury in order to reduce the rate of secondary chondral lesions.
Materials and Methods
 In this cross sectional study, 438 consecutive patients who underwent ACL reconstruction between Aug 2007 and Feb 2013 in  Shahid Gazi Hospital (Tabriz/Iran) were enrolled. Arthroscopic findings related to chondral lesions and the study variables including age, sex, BMI, time from injury and the mechanism of trauma were recorded. The data were analyzed using descriptive and inferential statistical tests using SPSS software.
Results:
The mean age of the patients was 29.3 (range: 17-53) years, and the mean BMI was 25 (range: 18-33) kg/m². The mean time from injury (TFI) was 24 (range 1–180) months. A total of 298(67.8%) patients had one or more chondral lesions and 56 (12.8%) had grade 3 and 4 chondropathies. We found a significant correlation between the age of the patients and the existence of chondropathy (R=0.32, p<0.001). According to our analysis the age of the patients was the best predictor of chondral lesions and each year of aging increases the chance of severe chondropathy around 8% (OR=1.08, 95%CI (1.04-1.13)). Significant correlation was also found between time from injury and chondral lesions .The cut-off point to predict significant increases of chondral lesions was around 12 months after injury. (Area under the curve [AUC] = 0.57; with 51% -63% CI; sensitivity = 62%; specificity = 50%).
Conclusions:
The age of the patients and the time interval from injury are the main predictors of chondral lesions associated with ACL injury. ACL reconstruction is best carried out within the first 12 months post injury in order to minimize the risk of secondary chondral lesions.