Relationship Between Timing of Anterior Cruciate Ligament Reconstruction and Chondral Injuries: A Systematic Review and Meta-analysis

Abstract

Background: After anterior cruciate ligament (ACL) injury, the optimal timing of ACL reconstruction and the influence of this timing on chondral damage remain unclear. Purpose: To assess the effect of timing of ACL reconstruction on the presence of chondral injuries via a systematic review and meta-analysis. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: Two reviewers independently performed systematic literature searches of 5 online databases using the Cochrane methodology for systematic reviews. Eligibility criteria were any comparative study of patients aged >16 years that assessed the relationship between timing of primary ACL reconstruction surgery and rates of chondral injuries. Meta-analysis was conducted using a random-effects model. Results: After screening, 14 studies (n = 3559 patients) out of 2363 titles met the inclusion criteria: 3 randomized controlled trials (n = 272), 3 prospective cohort studies (n = 398), and 8 retrospective cohort studies (n = 2889). In analysis of the studies, chondral injury rates were compared between ACL reconstructions performed before and after 3 time points: 3, 6, and 12 months after injury (eg, ≤3 vs >3 months). The rates of chondral injury increased with each time point. The increase was mostly due to low-grade injuries at 3 months (estimated odds ratio, 1.914; 95% CI, 1.242-2.949; P = .003), with the increase in high-grade injuries becoming predominant after 12 months (estimated odds ratio, 3.057; 95% CI, 1.460-6.40; P = .003). Conclusion: Our findings suggest that delaying ACL reconstruction surgery results in a higher rate of chondral injuries and the severity of these lesions worsens with time. These findings are comparable with those of our previously published study, which demonstrated a higher risk of meniscal tears associated with delayed ACL surgery. When ACL reconstruction is indicated, surgery ≤3 months after injury is associated with a lower risk of intra-articular damage. Registration: CRD42016032846 (PROSPERO).

What’s New in Sports Medicine

“…ACL reconstruction performed >3 months after the injury was associated with higher medial meniscal tear incidence compared with procedures performed within 3 months after the injury; however, there was no difference in lateral meniscal tear incidence. Similarly, Prodromidis et al 5 found increasing rates of chondral injury associated with ACL reconstruction procedures performed at 3 months, 6 months, and 12 months after the injury. In ACL reconstruction procedures performed at 3 months, the chondral injuries were primarily low-grade, whereas, in those procedures performed at 12 months, the injuries were predominantly high-grade.…”

Trends in Pediatric Anterior Cruciate Ligament Reconstruction: The Effect of COVID-19

“…26 Understanding the extent to which the decrease in surgical volume was due to decreased injury versus delayed surgery is important because studies have shown that ACLR delays are associated with worse outcomes. [10][11] It is customary to schedule ACLR within 3 months of injury due to the potential negative effects associated with delaying surgery, such as increased chondral lesions and increased risk of meniscal injuries and irreparable meniscal tears. [10][11] This became more difficult as many elective surgeries were delayed or cancelled due to the COVID-19 pandemic.…”

“…[10][11] It is customary to schedule ACLR within 3 months of injury due to the potential negative effects associated with delaying surgery, such as increased chondral lesions and increased risk of meniscal injuries and irreparable meniscal tears. [10][11] This became more difficult as many elective surgeries were delayed or cancelled due to the COVID-19 pandemic. [8][9] As providers counsel patients about preferred surgical timing for ACLR, both during the COVID-19 pandemic and beyond, they must consider the negative impact of delayed ACLR.…”

“…While surgery should be delayed until effusions reduce and range of motion of the knee returns, further delaying ACLR is associated with a higher rate of chondral injuries and increased severity of these lesions. [10][11] Given the aforementioned changes brought about by COVID-19, we suspect that the rates of ACLR decreased substantially since the pandemic began in the United States, around March 2020, with a rise in incidence when many athletes returned to play. To date, no formal studies have examined how ACL reconstruction rates in the pediatric and adolescent patient population have been affected by the COVID-19 pandemic.…”

Impediments to Meniscal Repair: Factors at Play Beyond Vascularity

“…Timing prior to the procedure is also an important biomechanical consideration. While waiting can calm inflammation to enhance repair potential, it must be balanced with the increased risk of other injuries that can occur in this timeframe ( Fok and Yau, 2013 ; Kolin et al, 2021 ; Prodromidis et al, 2021 ).…”