Progress Assessment of Injuries Associated to Anterior Cruciate Ligament Injuries

INTRODUCTION Anterior cruciate ligament rupture is a common injury in sports practice. It can be associated to many other injuries; the most frequent ones include meniscal and chondral injuries. Those injuries may be acute as a result of trauma, or chronic as a result of instability occasioned by anterior cruciate ligament injuries(1). Menisci play an important functional role in the knee, because they enhance joint congruence, reduce cartilage stress, increase joint stability, and lend absorption to impacts. Together, the menisci transmit about 50% of joint load (2,3). Meniscal loss reduces tibial contact area by about 50-70% resulting in an increased stress both on tibia and on femur(4). Joint cartilage is a complex tissue largely constituted of type-2 collagen. It has the ability of dealing with strong forces during many cycles, but has a poor ability to regenerate after an injury(5). Thus, the injuries associated to anterior cruciate ligament lead to a progressive degeneration of the joint cartilage, causing pain, edema, and limb function loss(6-9). anterior cruciate ligament reconstruction is a well established surgery in orthopaedic practice; it is indicated for the great majority of patients, particularly in symptomatic patients wanting to resume sports practice. This article intends to provide potentially assisting data for deciding on the best moment to operate, considering the likelihood of a higher number of secondary injuries (either chondral or meniscal) with time elapsed until the moment of surgery. CASE SERIES AND METHODS A retrospective study was conducted in order to analyze injuries associated to anterior cruciate ligament injuries. Seventytwo knees of 71 patients (8 women and 63 men) submitted to arthroscopic anterior cruciate ligament reconstruction surgery were assessed. all surgeries were performed by only one surgeon, in the period of 2001 to 2005. All patients presented as mechanism of trauma torsional injuries, most of them as a result of sports practice. The time interval between trauma and surgery ranged from 2 to 239 months, and patients’ ages ranged from 16 to 56 years, with an average of 31.9 years. Patients with associated ligament injuries were excluded from the study. The anterior cruciate ligament was the only injured ligament, either by magnetic resonance and physical examination (under anesthesia) findings, or by intra-operative confirmation. Meniscal and cartilaginous injuries were assessed. Meniscal injuries were classified by the criteria described by O`Connor into longitudinal, horizontal, oblique, and radial, and according to its position at meniscal horn as anterior, posterior, or body. Cartilaginous injuries were classified by employing the OuterBridge criteria into four types: softening, fibrillation, fissure and erosion. For the statistical analysis, the incidence of both meniscal and chondral injuries was divided into periods according to the progression time of injury until surgery. Time intervals of 2-3 months, 4-6 months, 7-12 months, 13-24 months, and above 24 months were assessed. This variable was named “time until surgery”. The existence of an association between months until surgery and the presence of medial meniscal injury (MMI), lateral meniscal SUMMARY Purpose: We reviewed 71 patients diagnosed with anterior cruciate ligament (ACL) injury on 72 knees. The incidence of associated injuries (meniscal and joint cartilage injuries) were evaluated according to the time elapsed until ACL reconstruction. Study design: Retrospective case series. Methods: Statistical analysis of the relationship between the time elapsed until surgery and the increase of associated lesions. Results: There was no statistically significant difference on the incidence of joint-cartilage and meniscal injuries assessed