Delay of Timing of Anterior Cruciate Ligament Reconstruction Is Associated With Lower Risk of Arthrofibrosis Requiring Intervention

Agarwal, Amil R.; Harris, Andrew B.; Tarawneh, Omar; Malyavko, Alisa; Kreulen, R. Timothy; Thakkar, Savyasachi C.; Doerre, Teresa

doi:10.1016/j.arthro.2023.01.102

Cited by 13 publications

(5 citation statements)

References 23 publications

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“…Many prior studies have examined the effects of surgical timing on complications following ACLR and have reported variable findings. In a retrospective cohort study of 15,645 patients, Agarwal et al found that a delay in ACLR of at least six weeks after injury was associated with a 65% risk reduction of operative intervention for arthrofibrosis in patients younger than 40 years [ 21 - 23 ]. In contrast, previous literature has shown that a delay in surgery is associated with a higher rate of meniscal tears and cartilage lesions [ 24 - 28 ].…”

Section: Discussionmentioning

confidence: 99%

Anterior Cruciate Ligament Reconstruction Surgery Outcomes: A Comparison Between Patients Who Underwent the Procedure During the COVID-19 Pandemic and a Cohort Treated Prior to the Pandemic

Wolterink,

Gaudiani,

Beydoun

et al. 2024

Cureus

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Background and objective During the coronavirus disease 2019 (COVID-19) pandemic, many elective orthopedic surgeries, including anterior cruciate ligament reconstruction (ACLR), were temporarily postponed. The purpose of this study was to compare the outcomes of ACLR in patients who underwent surgery during the COVID-19 pandemic with those in a cohort treated before the pandemic. Materials and methods This retrospective review compared patients who underwent primary ACLR during two periods: March to June 2020 (the pandemic group) and January to December 2018 (the pre-pandemic group). Matched cohorts (1:1) were created using propensity matching. Time from injury-to-first visit, injury-to-surgery, and first visit-to-surgery were calculated. Subjective and objective outcomes, minimal clinically important difference (MCID) achievement, and complication rates were recorded for up to two years postoperatively. Statistical analysis included 𝛘2 or Fisher’s exact tests for categorical data, and t- or Wilcoxon signed-rank tests for continuous data with significance set at P < 0.05. Results The pandemic and pre-pandemic groups consisted of 33 and 217 patients, respectively. Matched cohorts consisted of 33 patients each. The time from injury-to-surgery and the first visit-to-surgery was prolonged in the pandemic group. When unmatched, visual analog scale (VAS) scores at three months postoperatively and Patient-Reported Outcomes Measurement Information System (PROMIS)-pain interference (PI) at six months postoperatively and at the final follow-up were higher in the pandemic group. When matched, PROMIS-PI at six months postoperatively was higher in the pandemic group, and VAS scores at one year postoperatively were higher in the pre-pandemic group. MCID achievement and complication rates did not significantly differ between the groups. Conclusions ACLR procedures were significantly delayed in the early months of the COVID-19 pandemic. While patients treated before and during the pandemic experienced varying pain levels during recovery, their functional outcomes, MCID achievement, and complication rates did not differ significantly.

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Section: Discussionmentioning

confidence: 99%

Anterior Cruciate Ligament Reconstruction Surgery Outcomes: A Comparison Between Patients Who Underwent the Procedure During the COVID-19 Pandemic and a Cohort Treated Prior to the Pandemic

Wolterink,

Gaudiani,

Beydoun

et al. 2024

Cureus

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“…On the contrary, there is evidence that an early ACL reconstruction can lead to arthrofibrosis [ 15 , 59 ]. Conversely, Agarwal et al [ 60 ] found that postponing ACL reconstruction by a minimum of 6 weeks in patients below 40 years of age is linked to a 65% decrease in the likelihood of requiring surgical intervention for arthrofibrosis. Moreover, delaying the procedure by at least 10 weeks in patients aged 40 years and above is associated with a 35% reduction in the risk of surgical intervention for arthrofibrosis [ 60 ].…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, Agarwal et al [ 60 ] found that postponing ACL reconstruction by a minimum of 6 weeks in patients below 40 years of age is linked to a 65% decrease in the likelihood of requiring surgical intervention for arthrofibrosis. Moreover, delaying the procedure by at least 10 weeks in patients aged 40 years and above is associated with a 35% reduction in the risk of surgical intervention for arthrofibrosis [ 60 ]. In line with other studies [ 20 , 21 , 38 ], we noted no differences between the groups regarding extension deficits and Range-of-Motion after one month and at the last measurement date.…”

Section: Discussionmentioning

confidence: 99%

The optimal window for reconstruction of the anterior cruciate ligament (ACL) with respect to quadriceps atrophies lies within 21 to 100 days

Widhalm,

Draschl,

Horns

et al. 2024

PLoS ONE

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Purpose The study’s objective was to determine the optimal window for anterior cruciate ligament (ACL) reconstruction with respect to quadriceps atrophies and clinical outcome. Methods For this retrospective, comparative study, 115 patients aged under 35 were included, who received an ACL reconstruction between 2011 and 2016. They were divided into four groups, depending on the time to surgery, to determine the optimal window for reconstruction: (group 1: ≤21 d, group 2: <21d-56d≥, group 3: >56d-100d≥, group 4: >100d). Follow-up was performed one month postoperatively, after a mean of 4.9 (±5.3) months, and after a mean of 3.5 (±1.4) years. Primary endpoints included quadriceps muscle status, range of motion (ROM), pain, swelling, the International Knee Documentation Committee Subjective Knee Form (IKDC), the Lysholm-Score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Tegner-Activity-Scale (TAS). Results Significantly more quadriceps atrophies were observed in group 1 and group 4, representing reconstructions earlier than 21 and later than 100 days (29% and 41% vs. 9%; p = 0.032). The measurements of knee extension (p = 0.082) and ROM (p = 0.123) were comparable in all groups. Group 1 showed the least pain (0% vs. 15%; p = 0.285) and swelling (0% vs. 23%; p = 0.077) compared to all other groups one month postoperatively. A comparison of postoperative clinical scores revealed no significant differences, with group 1 exhibiting the lowest TAS levels. Conclusion In patients who underwent ACL reconstruction within three weeks or after more than 100 days, a significantly higher incidence of quadriceps atrophy was observed, possibly attributable to the initial inflammatory phase or the delayed reconstruction affecting quadriceps function. However, this impairment may not be observable in elite athletes who undergo reconstruction within hours of the injury.

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“…Prior to ACLR, athletes should complete a prehabiltation program that emphasizes pain reduction and effusion control, the recovery of knee-specific range of motion, the optimization of quadriceps strength as well as thorough patient/athlete education [12,[59][60][61]121]. The medical team (i. e., surgeon and rehabilitation specialists) should agree on the objective readiness of the knee for surgery, as preoperative knee range of motion and strength are significant predictors of the postoperative outcome after ACLR [63,64,119,122,123]; and although the reasons for surgical complications after ACLR are multifactorial [121,124], a minimum of a two-to six-week period of prehabilitation (between ACL injury and ACLR) is indicated to reduce the risk of postoperative knee arthrofibrosis [121,124]. Likewise, compliance within a six-week prehabilitation program may also accelerate postoperative recovery and the RTS timeline for an athlete [65].…”

Section: Medical Recommendations For Rehabilitation After Aclrmentioning

confidence: 99%

Return to the Pre-Injury Level of Sport after Anterior Cruciate Ligament Reconstruction: A Practical Review with Medical Recommendations

Solie,

Tollefson,

Doney

et al. 2024

Int J Sports Med

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Returning to sport after anterior cruciate ligament reconstruction (ACLR) can be a challenging and complex process for the athlete, with the rate of return to the pre-injury level of sport observed to be less than athlete expectations. Of the athletes that do return to sport (RTS), knee re-injury rates remain high, and multiple studies have observed impaired athletic performance upon RTS after ACLR as well as reduced playing time, productivity, and career lengths. To mitigate re-injury and improve RTS outcomes, multiple RTS after ACLR consensus statements/clinical practice guidelines have recommended objective RTS testing criteria to be met prior to medical clearance for unrestricted sports participation. While the achievement of RTS testing criteria can improve RTS rates after ACLR, current criteria do not appear valid for predicting safe RTS. Therefore, there is a need to review the various factors related to the successful return to the pre-injury level of sport after ACLR, clarify the utility of objective performance testing and RTS criteria, further discuss safe RTS decision-making as well as present strategies to reduce the risk of ACL injury/re-injury upon RTS. This article provides a practical review of the current RTS after ACLR literature, as well as makes medical recommendations for rehabilitation and RTS decision-making after ACLR.

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Delay of Timing of Anterior Cruciate Ligament Reconstruction Is Associated With Lower Risk of Arthrofibrosis Requiring Intervention

Cited by 13 publications

References 23 publications

Anterior Cruciate Ligament Reconstruction Surgery Outcomes: A Comparison Between Patients Who Underwent the Procedure During the COVID-19 Pandemic and a Cohort Treated Prior to the Pandemic

Anterior Cruciate Ligament Reconstruction Surgery Outcomes: A Comparison Between Patients Who Underwent the Procedure During the COVID-19 Pandemic and a Cohort Treated Prior to the Pandemic

The optimal window for reconstruction of the anterior cruciate ligament (ACL) with respect to quadriceps atrophies lies within 21 to 100 days

Return to the Pre-Injury Level of Sport after Anterior Cruciate Ligament Reconstruction: A Practical Review with Medical Recommendations

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