Acute and subacute anterior cruciate ligament reconstructions are associated with a higher risk of revision and reoperation

Purpose: (1) Report concomitant cartilage and meniscal injury at the time of anterior cruciate ligament reconstruction (ACLR), (2) evaluate the risk of aseptic revision ACLR during follow-up, and (3) evaluate the risk of aseptic ipsilateral reoperation during follow-up. Methods: Using a United States integrated healthcare system’s ACLR registry, patients who underwent primary isolated ACLR were identified (2010–2018). Multivariable Cox proportional-hazards regression was used to evaluate the risk of aseptic revision, with a secondary outcome evaluating ipsilateral aseptic reoperation. Outcomes were evaluated by time from injury to ACLR: acute (< 3 weeks), subacute (3 weeks–3 months), delayed (3–9 months), and chronic (≥ 9 months). Results: The final sample included 270 acute (< 3 weeks), 5971 subacute (3 weeks–3 months), 5959 delayed (3–9 months), and 3595 chronic (≥ 9 months) ACLR. Medial meniscus [55.4% (1990/3595 chronic) vs 38.9% (105/270 acute)] and chondral injuries [40.0% (1437/3595 chronic) vs 24.8% (67/270 acute)] at the time of ACLR were more common in the chronic versus acute groups. The crude 6-year revision rate was 12.9% for acute ACLR, 7.0% for subacute, 5.1% for delayed, and 4.4% for chronic ACLR; reoperation rates a 6-year follow-up was 15.0% for acute ACLR, 9.6% for subacute, 6.4% for delayed, and 8.1% for chronic ACLR. After adjustment for covariates, acute and subacute ACLR had higher risks for aseptic revision (acute HR 1.70, 95% CI 1.07–2.72, p = 0.026; subacute HR 1.25, 95% CI 1.01–1.55, p = 0.040) and aseptic reoperation (acute HR 2.04, 95% CI 1.43–2.91, p < 0.001; subacute HR 1.31, 95% CI 1.11–1.54, p = 0.002) when compared to chronic ACLR. Conclusions: In this cohort study, while more meniscal and chondral injuries were reported for ACLR performed ≥ 9 months after the date of injury, a lower risk of revision and reoperation was observed following chronic ACLR relative to patients undergoing surgery in acute or subacute fashions. Level of evidence III.