A comparison of early and delayed arthroscopically-assisted reconstruction of the anterior cruciate ligament using hamstring autograft

Abstract

Delayed rather than early reconstruction of the anterior cruciate ligament is the current recommended treatment for injury to this ligament since it is thought to give a better functional outcome. We randomised 105 consecutive patients with injury associated with chondral lesions no more severe than grades 1 and 2 and/or meniscal tears which only required trimming, to early (< two weeks) or delayed (> four to six weeks) reconstruction of the anterior cruciate ligament using a quadrupled hamstring graft. All operations were performed by a single surgeon and a standard rehabilitation regime was followed in both groups. The outcomes were assessed using the Lysholm score, the Tegner score and measurement of the range of movement. Stability was assessed by clinical tests and measurements taken with the KT-1000 arthrometer, with all testing performed by a blinded uninvolved experienced observer. A total of six patients were lost to follow-up, with 48 patients assigned to the delayed group and 51 to the early group. None was a competitive athlete. The mean interval between injury and the surgery was seven days (2 to 14) in the early group and 32 days (29 to 42) in the delayed group. The mean follow-up was 32 months (26 to 36). The results did not show a statistically significant difference for the Lysholm score (p = 0.86), Tegner activity score (p = 0.913) or the range of movement (p = 1). Similarly, no distinction could be made for stability testing by clinical examination (p = 0.56) and measurements with the KT-1000 arthrometer (p = 0.93). Reconstruction of the anterior cruciate ligament gave a similar clinical and functional outcome whether performed early (< two weeks) or late at four to six weeks after injury.

Deep vein thrombosis and thromboprophylaxis in arthroscopic anterior cruciate ligament reconstruction

“…Further this is not a comparative study with and without thromboprophylaxis. However, if we look at a study published earlier9 and compare it with the present study, one can see that despite not receiving thromboprophylaxis there is not much difference in the incidence of DVT. Prospective randomized clinical trials with and without thromboprophylaxis for arthroscopic assisted ACL reconstruction are required to assess the risk benefit of the use of DVT prophylaxis in these subset of patients.…”

“…To the best of our knowledge this is the only study in literature which has focused on incidence of DVT following ACL reconstruction in a prospective fashion. In one of the earlier studies published9 authors compared the outcome of early versus delayed surgery, in which a single dose of Fondapaurinaux (LMWH) was used in the post operative period and no patient had any evidence of DVT. These studies were performed at the same institution at two different points in time.…”

“…No patient was given non steroidal antiinflammatory drugs for the first 2 weeks following surgery. For further technical details about the procedure the reader is referred to our earlier reported series 9. Postoperative analgesia was provided with intravenous tramadol for 24 h. The patient was mobilized and discharged on the first postoperative day.…”

Anterior cruciate ligament reconstruction

“…Although some studies have not reported significant differences in objective and subjective clinical outcomes between early (<2 weeks) versus late ACL reconstruction (>4–12 weeks),30 most recent recommendations, based on moderate quality evidence, support surgery timing at 3 weeks to 5 months after injury 5. Surgery within this period is associated with improved objective knee stability, higher activity level and better knee function when compared with reconstruction after 5 months 10 23 31.…”

Knee Stiffness After ACL Reconstruction

“…However, 2 recent randomized control trials of acute (< 2 weeks) versus delayed ACL reconstruction with hamstring tendon autograft showed no difference in postoperative ROM or functional outcome at any time point. 22,23 We do not routinely delay surgical intervention in patients with acute ACL injuries; however, we do encourage formal physiotherapy focused on regaining full extension and active quadriceps function while patients are awaiting surgery.…”