The Association Between Delaying Anterior Cruciate Ligament Reconstruction in Adolescents and Increasing Meniscal and Chondral Pathology: A Cohort Study of 2740 Adolescents

Background: A growing body of evidence surrounds secondary meniscal and cartilage pathology after delay to anterior cruciate ligament (ACL) reconstruction (ACLR). Many of these studies focus on or include an adult population. Purpose: To elucidate the prevalence of secondary meniscal and chondral pathology with delay to ACLR in the adolescent population as well as examine the influence of sex, skeletal maturity, and trends over the years. Study Design: Cohort study; Level of evidence, 3. Methods: A prospective database was used to identify all patients younger than 19 years who underwent ACLR at the authors’ center between January 1993 and April 2023. Operative data including meniscal and chondral injury and treatment were prospectively recorded at the time of ACLR. A retrospective analysis was performed assessing the relationship between meniscal treatment and chondral injury at ACLR and the time from injury to ACLR, controlling for age, sex, and decade of surgery with multiple regression analysis. Prevalence of meniscal and chondral surgery at ACLR was examined over time and compared between sexes and age groups. Results: A total of 2740 patients were identified with a median age of 17 years (range, 7-19 years). Surgical delay of 5 to 12 months increased the risk of medial meniscal tear requiring surgery by 1.6 (95% CI, 1.1-2.2; P = .007). Surgical delay >12 months increased the risk of medial meniscal tear requiring surgery by 4.2 (95% CI, 3.1-5.8; P = .001) and medial chondral injury by 3.4 (95% CI, 2.2-5.1; P = .001). The repairability of medial meniscal tears decreased with greater delay to reconstruction (57% before 5 months vs 19% after 12 months; P = .001). Lateral meniscal tear repairability followed a similar trend. More male than female participants had secondary pathology (46% vs 39%; P = .001). Patients aged 14-19 years had more meniscal surgery and chondral pathology compared with those younger than 14 years (45% vs 30%, P = .001). Conclusion: Surgical delay >4 months from injury is associated with a steady increase in the prevalence of medial meniscal and chondral pathology in adolescents with ACL rupture. If ACL surgery is delayed >12 months, the odds of requiring medial meniscal surgery is increased by a factor of 4 and the odds of having a chondral lesion is increased by a factor of 3. Timely diagnosis of ACL injury and early surgical referral are important for reducing the odds of meniscal and chondral pathology in adolescents.