Early and Delayed Surgery for Isolated ACL and Multiligamentous Knee Injuries Have Equivalent Results: A Systematic Review and Meta-analysis

Abstract

Background: Early surgery for acute ligamentous injuries has recently shown good clinical and functional outcomes. Purpose: To assess the advantages of early vs delayed surgery in patients undergoing isolated anterior cruciate ligament (ACL) or multiligament-injured knee (MLIK) surgery. Study Design: Meta-analyses of Level 1, 2, and 3 studies; Level of evidence, 4. Methods: A systematic search was performed via PubMed, EMBASE, and Cochrane for studies reporting outcomes of timing of surgery after isolated ACL injury or in the MLIK setting using accelerated rehabilitation protocols. Two analyses were conducted to differentiate early and delayed treatment (3- and 6-week cutoffs). Collected outcomes included meniscal or chondral lesions, failure and reoperation rates, range of motion (ROM) deficits, other complications, muscle strength, instrumented laxity, and functional outcomes. Outcomes were reported in risk ratios (RR) or mean differences with 95% CIs. Results: For timing of isolated ACL surgery, 16 studies were included with 2093 patients. High-grade evidence indicated that there were no differences in meniscal or chondral lesions, failure and reoperation rates, stiffness, ROM deficits, complications, muscle strength, instrumented laxity, and functional outcomes between patients treated early and late (all P > .05). When including only studies that set no preoperative criteria for early surgery, the findings were similar. Regarding MLIK surgery, 14 studies were included with 1172 patients. Low evidence was noted for the following: patients treated early had significantly fewer meniscal injuries (RR, 0.7; P = .04) and chondral injuries (RR, 0.5; P < .001), while no differences were found in reoperation rates, complications, stiffness, ROM deficits, muscle strength, instrumented laxity, and functional outcomes between the groups. Other than higher Lysholm scores in the early group for the 3-week analysis (mean difference, 6.8; P = .01), there were no differences between cutoff analyses. Conclusion: This systematic review with meta-analysis found no differences in clinical and functional outcomes between early and delayed surgery for isolated ACL injuries. For MLIK injuries, there were also no differences in surgical outcomes between early and delayed surgery.

Presentation and Surgical Management of Multiple Ligament Knee Injuries

“…The median time from injury to initial ligament/capsule surgery was 64 days, with an IQR of 23 to 190 days. The ideal timing for surgery has yet to be conclusively determined [25][26][27] . Early surgery has been associated with an increased risk of loss of motion 28,29 .…”

Pattern of Anterior Cruciate Ligament Reconstruction (ACLR) among Athletes in Malaysia between 2015 and 2020

“…Also, the expectation of return to sports activity among them will be higher which is within 1 year following complete ACLR post-operative rehabilitations (Fabricant et al, 2016). A recent systematic review with meta-analysis which involved 2093 patients documented that there were no difference in clinical and functional outcomes between those receiving early or delayed (3 and 6 weeks cut-off) ACLR surgery for isolated ACL injury (Vermeijden et al, 2022). However, despite this report, the question on the success of return to sports remains unanswered.…”

Team Approach: Treatment of Traumatic Dislocations of the Knee

“…The effects of high rates of secondary injuries after knee dislocations are further pronounced in the high rates of patients (42%) who develop osteoarthritis after knee dislocations 62 . A recent systematic review showed that patients treated early had significantly lower rates of secondary injury; however, further studies are needed to compare functional outcomes between patients treated by acute versus delayed ligamentous repair or reconstruction 63 . However, not all patients can have an early repair, such as the case of our patient where significant knee swelling, and the healing of the tendon repair was a barrier to immediate surgical intervention.…”