Acute ACL reconstruction shows superior clinical results and can be performed safely without an increased risk of developing arthrofibrosis

Abstract

Purpose To compare acute ACL reconstruction (ACLR) within 8 days of injury with delayed reconstruction after normalized range of motion (ROM), 6-10 weeks after injury. It was hypothesized that acute ACL reconstruction with modern techniques is safe and can be beneficial in terms of patient-reported outcomes and range of motion. Methods The effect of acute and delayed ACLR was randomized studied on 70 patients with high recreational activity level, Tegner level 6 or more, between 2006 and 2013. Patient-reported outcomes, objective IKDC, KOOS, and manual stability measurements were documented during the 24-month follow-up period. Results The acute ACLR group did not result in increased stiffness and showed superior outcome regarding strength and how the patient felt their knee functioning at 24 months. In addition, the acute group was not inferior to the delayed group in any assessment. Regarding patient-related outcomes in KOOS, both groups showed significant improvements in all subscales, but no difference was found between the groups. Functional return (FR) rate was almost double compared to the Swedish knee ligament register and treatment failure (TF) rate was reduced by half, no significant difference between the groups. No difference regarding cyclops removal, re-injury of ACL or meniscus was found between the two surgical timing groups. Conclusion Acute ACLR within 8 days of injury does not appear to adversely affect ROM or result in increased stiffness in the knee joint and was not inferior to the delayed group in any assessment when compared to delayed surgery. Level of evidence I.

Quick Recovery and No Arthrofibrosis in Acute Anterior Cruciate Ligament Reconstruction: a Prospective Trial of Early versus Delayed Reconstruction

“…As a result, subsequent studies adopted a similar accelerated rehabilitation protocol (12,13,28). This, along with the use of modern surgery technique, may explain why recent studies reported no clinical difference between early versus chronic ACLR supporting our findings (6,7,29 (31). Different studies reported other advantages of early surgery such as less muscle atrophy and less risk of exposing the knee to subsequent injuries associated with recurring instability such as meniscal and chondral injuries (11,32).…”

“…Recent studies, otherwise, reported no risk of arthrofibrosis with acute reconstruction showing similar or better outcomes than delayed ACLR (6,7). Furthermore, early surgery seems to be more cost-effective and can decrease the risk of subsequent meniscal or cartilage lesions by reducing the time between injury and reconstruction (8)(9)(10).…”

Cyclops Lesions of the Knee: A Narrative Review of the Literature

“…However, the study found a significantly higher incidence of the lesion in women and a significantly smaller notch in those with cyclops lesions. 9 von Essen et al 39 found no difference in the incidence of the lesion in patients undergoing ACLR within 8 days versus 6 weeks after injury.…”

A Systematic Review of Randomized Controlled Trials in Anterior Cruciate Ligament Reconstruction: Standard Techniques Are Comparable (299 Trials With 25,816 Patients)

“…42,43 Interestingly, patients who had early ACLR were found to have significantly greater patellofemoral cartilage loss measured on magnetic resonance imaging at 5 years. 44 Eriksson et al 45 also compared early versus delayed and reported their outcomes at 6 months, 1 year, 46 and 2 years 47 and reported no significant differences except for more sick days leave taken by patients in the delayed group. The remining 3 RCTs also reported no significant differences (Table 4).…”

“…The remining 3 RCTs also reported no significant differences (Table 4). [41][42][43][44][45][46][47][48][49][50][51]…”