Timing of Anterior Cruciate Ligament Reconstruction and Relationship With Meniscal Tears: A Systematic Review and Meta-analysis

Abstract

Background: Anterior cruciate ligament (ACL) ruptures are common, but the ideal timing for ACL reconstruction after injury is unclear with regard to meniscal insult. Purpose: To determine whether there is a relationship between timing from ACL rupture to ACL reconstruction and development of meniscal tears within this period. Study Design: Systematic review and meta-analysis. Methods: A systematic literature search was undertaken independently by 2 reviewers using the Cochrane method for systematic reviews in 5 online databases. The reviewers performed independent data extraction and assessment of risk of bias and study quality. The search included any comparative study, including randomized controlled trials (RCTs), prospective and retrospective cohort studies, and case-control studies of an adult population, that assessed the relationship between timing of ACL reconstruction surgery and rates of meniscal tears. Results: After screening, 12 studies (No. of participants = 3042) out of 3390 records were included for analysis: 3 RCTs (n = 272), 2 prospective cohort studies (n = 307), and 7 retrospective cohort studies (n = 2463). In analysis of these studies, rates of reported meniscal tears were compared for ACL procedures performed at 3 and 6 months after injury. Meta-analysis of 5 studies (n = 2012) showed that ACL reconstruction performed >3 months after injury was associated with a higher rate of medial meniscal tears compared with ACL reconstruction performed within 3 months of injury (estimated OR, 2.235; 95% CI, 1.183-4.223; P = .013) but not with a higher rate of lateral meniscal tears. Similarly, meta-analysis of 4 studies (n = 990) showed that ACL reconstruction performed >6 months after injury was associated with a higher rate of medial meniscal tears compared with ACL reconstruction performed within 6 months of injury (estimated OR, 2.487; 95% CI, 1.241-4.984; P = .01) but not with a higher rate of lateral meniscal tears. Conclusion: Our results suggest that delay of ACL reconstruction surgery >3 months after injury is associated with a higher rate of medial meniscal tears within this prereconstruction time frame. Further high-quality prospective studies may help determine whether this is a causal effect. However, based on current evidence, in those patients for whom ACL reconstruction is indicated, ACL reconstruction within 3 months of injury may be recommended. Registration: CRD42016032846 (PROSPERO)

Prevalence and Incidence of Chondral and Meniscal Lesions in Patients Undergoing Primary and Subsequent Revision Anterior Cruciate Ligament Reconstruction: An Analysis of 213 Patients From the SANTI Group

“…Several studies reported that an increasing time from ACL injury to reconstruction was associated with a greater risk of secondary intra-articular lesions. 26,28,29 Additionally, the high prevalence of meniscal injuries during the revision procedure was highlighted by Yoon et al, 40 with a major association between concurrent meniscal tears and R-ACLR. Those authors reported that only 15 patients in a cohort of 86 patients (17.4%) had no tears, regardless of patient age.…”

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.…”

Is the die cast? Anterior cruciate ligament injury and osteoarthritis

“…A delay to reconstruction of more than three months is associated with a higher incidence of medial meniscal tears. 41 In the past, early ACL reconstruction was often recommended, before episodes of instability occur in patients who continued sporting activities that involve sidestepping and pivoting. 38 However, the evidence that this occurs remains conflicting.…”