We reviewed 5086 patients with a mean age of
30 years (9 to 69) undergoing primary reconstruction of the anterior cruciate
ligament (ACL) in order to determine the incidence of secondary
pathology with respect to the time between injury and reconstruction.
There was an increasing incidence of medial meniscal tears and chondral damage,
but not lateral meniscal tears, with increasing intervals before
surgery. The chances of requiring medial meniscal surgery was increased
by a factor of two if ACL reconstruction was delayed more than five
months, and increased by a factor of six if surgery was delayed
by >
12 months. The effect of delaying surgery on medial meniscal injury
was also pronounced in the patients aged <
17 years, where a
delay of five to 12 months doubled the odds of medial meniscal surgery
(odds ratio (OR) 2.0, p = 0.001) and a delay of >
12 months quadrupled
the odds (OR 4.3, p = 0.001). Increasing age was associated with
a greater odds of chondral damage (OR 4.6, p = 0.001) and medial meniscal
injury (OR 2.9, p = 0.001), but not lateral meniscal injury. The
gender split (3251 men, 1835 women) revealed that males had a greater
incidence of both lateral (34% (n = 1114) Cite this article:
A 25-year-old male weightlifter felt increasing intractable low back pain during training but denied any acute injury. The physical examination, blood parameters, radiographs and MRI were unremarkable. He had been treated non-operatively by various means, with only temporary relief. The pressures in the lumbar paraspinal compartment were abnormally high and he was treated by surgical decompression. This gave rapid relief, he returned to training, and one year later the pain had not recurred.
We identified ten patients who underwent arthroscopic revision of anterior shoulder stabilisation between 1999 and 2005. Their results were compared with 15 patients, matched for age and gender, who had a primary arthroscopic stabilisation during the same period. At a mean follow-up of 37 and 36 months, respectively, the scores for pain and shoulder function improved significantly between the pre-operative and follow-up visits in both groups (p = 0.002), with no significant difference between them (p = 0.4). The UCLA and Rowe shoulder scores improved significantly (p = 0.004 and p = 0.002, respectively), with no statistically significant differences between groups (p = 0.6). Kaplan-Meier analysis for time to recurrent instability showed no differences between the groups (p = 0.2). These results suggest that arthroscopic revision anterior shoulder stabilisation is as reliable as primary arthroscopic stabilisation for patients who have had previous open surgery for recurrent anterior instability.