Optimal Timing of Anterior Cruciate Ligament Reconstruction in Patients With Anterior Cruciate Ligament Tear

Abstract

ImportanceThe timing of surgery has been regarded as a key factor in anterior cruciate ligament reconstruction (ACLR), and early vs delayed ACLR remains a controversial topic.ObjectiveTo synthesize up-to-date published data from randomized clinical trials (RCTs) comparing early vs elective delayed ACLR for patients with ACL deficiency, in terms of clinical outcomes and complications.Data SourcesThe PubMed, Cochrane Library, and Web of Science databases were systematically searched until September 9, 2022.Study SelectionAll published RCTs comparing clinical and functional outcomes and complications associated with early ACLR vs elective delayed ACLR.Data Extraction and SynthesisTwo reviewers independently extracted relevant data and assessed the methodological quality following the PRISMA guidelines.Main Outcomes and MeasuresDue to the clinical heterogeneity, the random-effects model was preferred. The primary outcomes were functional outcomes and complications. The Mantel-Haenszel test was used to evaluate dichotomous variables and the inverse variance method was used to assess continuous variables.ResultsThis meta-analysis included 972 participants in 11 RCTs stratified by follow-up duration. The following factors did not differ between early and delayed ACLR: operative time (mean difference, 4.97; 95% CI, −0.68 to 10.61; P = .08), retear (OR, 1.52; 95% CI, 0.52-4.43; P = .44), and infection (OR, 3.80; 95% CI, 0.77-18.79; P = .10). There were also no differences between groups in range of motion, knee laxity, International Knee Documentation Committee (IKDC rating scale), and Tegner score. IKDC score (mean difference, 2.77; 95% CI, 1.89-3.66; P < .001), and Lysholm score at 2-year follow-up (mean difference, 2.61; 95% CI, 0.74-4.48; P = .006) significantly differed between early and delayed ACLR. In addition, the timing of surgery was redefined in the included RCTs and subgroup analyses were performed, which validated the robustness of the principal results.Conclusion and RelevanceThis systematic review and meta-analysis found that early ACLR was not superior to delayed ACLR in terms of most factors analyzed, except for IKDC and Lysholm scores. This information should be available to patients with ACL deficiency and clinicians as part of the shared decision-making process of treatment selection.

More than six months delay in anterior cruciate ligament reconstruction is associated with a higher risk of pre-reconstruction meniscal and chondral damage

“…In contrast, a Meta-analysis performed by Shen et al . revealed better IKDC and Lysholm scores in patients who underwent early ACLR (within 10 wk) compared to those who underwent late ACLR (within four months) 17. Also, the meta-analysis by Kay et al .…”

“…16 In contrast, a Meta-analysis performed by Shen et al revealed better IKDC and Lysholm scores in patients who underwent early ACLR (within 10 wk) compared to those who underwent late ACLR (within four months). 17 Also, the metaanalysis by Kay et al demonstrated a significantly lower risk of concomitant meniscal injury, and chondral damage in patients who underwent an early ACLR (within six weeks) compared to those who underwent a late ACLR (up to 52 wk after the injury). 18 Almost the same results were reported in the metaanalysis performed by Kim et al, plus superior clinical function in the early ACLR group.…”

Delayed Meniscus Repair Lowers the Functional Outcome of Primary ACL Reconstruction

“…A meta-analysis by Shen et al evaluated 11 randomised controlled trials, including 972 patients in total, using the definition of early ACL reconstruction within 10 weeks. They found that early reconstruction was not associated with improved functional outcomes, nor with fewer complications [ 33 ]. Different time periods were defined by Evans et al, with early reconstructions within 3 weeks, and delayed reconstructions after 6 weeks [ 34 ], stating that there is still debate regarding the optimal timing.…”

Functional outcomes after anterior cruciate ligament reconstruction: unravelling the role of time between injury and surgery, time since reconstruction, age, gender, pain, graft type, and concomitant injuries

“…Our findings of the relevance of the time span between injury and reconstruction is, generally in accordance with the most recent evidence. Here, the authors conclude, that “early ACLR was superior to elective delayed ACLR in terms of the Lysholm score at 2 years and the IKDC score” [ 37 ]. In contrast, it is also important to notice that most of the clinical outcomes were not different between early and late reconstruction [ 37 ].…”

“…Here, the authors conclude, that “early ACLR was superior to elective delayed ACLR in terms of the Lysholm score at 2 years and the IKDC score” [ 37 ]. In contrast, it is also important to notice that most of the clinical outcomes were not different between early and late reconstruction [ 37 ]. As the measures between the ACL injury and reconstruction, like pre-operative rehabilitation affects function, they must be considered, likewise [ 38 ].…”