Does a Delay in Anterior Cruciate Ligament Reconstruction Increase the Incidence of Secondary Pathology in the Knee? A Systematic Review and Meta-Analysis

Abstract

Objective: Previous systematic reviews looking at timing of anterior cruciate ligament reconstruction (ACLR) examined the functional outcomes and range of motion; however, few have quantified the effect of timing of surgery on secondary pathology. The goal of this study was to analyze the effects of early ACLRs versus delayed ACLR on the incidence of meniscal and chondral lesions. Data Sources: We searched MEDLINE, EMBASE, and CINAHL on March 20, 2018, for randomized control trials (RCTs) that compared early and delayed ACLR in a skeletally mature population. Two reviewers independently identified trials, extracted trial-level data, performed risk-of-bias assessments using the Cochrane Risk of Bias tool, and evaluated the study methodology using the Detsky scale. A meta-analysis was performed using a random-effects model with the primary outcome being the total number of meniscal and chondral lesions per group. Results: Of 1887 citations identified from electronic and hand searches, we included 4 unique RCTs (303 patients). We considered early reconstruction as <3 weeks and delayed reconstruction as >4 weeks after injury. There was no evidence of a difference between early and late ACLR regarding the incidence of meniscal [relative risk (RR), 0.98; 95% confidence interval (CI), 0.74-1.29] or chondral lesions (RR, 0.88; 95% CI, 0.59-1.29), postoperative infection, graft rupture, functional outcomes, or range of motion. Conclusions: We found no evidence of benefit of early ACLR. Further studies may consider delaying surgery even further (eg, >3 months) to determine whether there are any real benefits to earlier reconstruction.

Evidence for the effects of prehabilitation before ACL-reconstruction on return to sport-related and self-reported knee function: A systematic review

“…Delayed compared to early ACLR is unlikely to result in postoperative differences in secondary knee pathologies (incidence of meniscal/ chondral lesions, postoperative infection, graft rupture) and functional outcomes [ 49 ] as well as two year self-reported knee function [ 27 ]. Against this background, it appears plausible that additional preoperative training prior to a delayed surgery may result in better postoperative function compared to early surgery.…”

“…This is in line with previous findings, which indicated that, more than half the ACLR can be avoided without aversively affecting outcomes using a delayed ACLR approach [ 27 ]. In line with current work applicable in non-professional or leisure time copers [ 49 ], delaying surgery for a minimum of 3 months after the ACL tear may be recommended [ 51 ].…”

Does Surgery for Cruciate Ligament and Meniscus Injury Increase the Risk of Comorbidities at 2 Years in the Military System?

“…9 Meniscus injury rates are higher than cruciate ligament injuries, with incidence rates of 8.27 per 1,000 person-years among male and female active duty personnel. 10 To date, several studies have failed to show superiority of one intervention over the other for cruciate ligament reconstruction 11,12 or the value of early surgical cruciate intervention 13 for reduction of pain and improvement of function. The heterogeneity of meniscus injuries, especially those who are present after trauma, makes broad, definitive conclusions about the value of a single management approach unrealistic.…”

Early ACLR and Risk and Timing of Secondary Meniscal Injury Compared With Delayed ACLR or Nonoperative Treatment: A Time-to-Event Analysis Using Machine Learning

“…Additionally, several existing meta-analyses have presented conflicting evidence on the effect of ACLR timing on secondary pathology such as meniscal injuries. 24,32,44 Traditional statistical methods have been indispensable in studying ACL pathology and are satisfactory for capturing population-wide features. However, these methods can be limited by both externally imposed bias and the internal constraints that hamper accurate individual-level predictions.…”