Functional outcome of an early anterior cruciate ligament reconstruction in comparison to delayed: Are we waiting in vain?

Manandhar, Rajeev Raj; Chandrashekhar, Karthik; Kumaraswamy, Vinay; Sahanand, Santosh; Rajan, David V.

doi:10.1016/j.jcot.2017.03.001

Cited by 25 publications

(64 citation statements)

References 20 publications

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“…Four studies, all with similar designs, methodology and surgical technique [6, 26, 27, 29], assessed Tegner activity scale at the end of the follow-up period (26–36 months), reporting no differences between the groups on individual assessments. One further study [28] recorded Tegner activity scale at a much earlier final follow-up of 6 months with a trend approaching significance in favour of early 4.15 ± 1.45 versus delayed surgery 3.72 ± 1.34 ( p = 0.06). Similarly, the four studies also assessed Lysholm scores at the same (26–36 months) follow-up with no differences found between the groups when assessed individually.…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, the four studies also assessed Lysholm scores at the same (26–36 months) follow-up with no differences found between the groups when assessed individually. One paper considered the International Knee Documentation Committee subjective rating score (IKDC) [35] with no difference between the groups, but with a trend towards significance in favour of early surgery when followed-up at 6 months ( p = 0.08) [28]. Visual analogue pain scores (VAS) were reported in one study [6] with no differences found between the groups at any of the follow-ups up until the final reviews at 24 months.…”

Section: Resultsmentioning

confidence: 99%

“…2. Two studies attempted randomisation; one via a computer-generated sequence [26], the second on basis of odd/even hospital numbers [28]. Whilst two studies attempted uniformity of follow-up using a single observer [26, 27], only one study was blinded to the timing of surgery [26].…”

Section: Resultsmentioning

confidence: 99%

“…When assessed individually, there were no differences found in Tegner activity scales between the groups in any of the five papers. Mananadhar et al [28] observed a trend towards significance in favour of early surgery at only the 6-month follow-up, whilst all the other similar studies reported no differences in outcomes from 12 to 24 months [26, 27, 29, 36]. Our meta-analysis found a 0.39 point greater Tegner activity scale score in the early surgical group ( p = 0.008) compared with the delayed group, suggesting a potentially beneficial role for early surgery in the young active cohort under review.…”

Section: Discussionmentioning

confidence: 99%

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Early or delayed anterior cruciate ligament reconstruction: Is one superior? A systematic review and meta-analysis

Ferguson

Palmer

Khan

et al. 2019

Eur J Orthop Surg Traumatol

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Background Anterior cruciate ligament (ACL) reconstruction is a rapidly developing orthopaedic field and an area of notable clinical equipoise. The optimal timing of surgery in an acute (< 3 weeks) or delayed (≥ 3 weeks) time frame remains unresolved with a 2010 meta-analysis concluding no difference between these two groups across multiple outcomes. In an era of evidence-based medicine, surgeons are still basing their decisions on when to operate on little more than anecdotal evidence and personal preference. Clear guidance is required to determine whether the timing of surgery can optimise outcomes in this largely young and active patient cohort. Methods A systematic literature search was performed in January 2018 of Embase, Medline and OpenGrey in accordance with (PRISMA) guidelines. A total of 658 articles were retrieved, with 6 suitable for inclusion, covering 576 ACL reconstructions. Four meta-analyses were performed assessing subjective measures of Tegner activity scale and Lysholm score, and objective measures of arthroscopically identified meniscal and chondral injury. Additional relevant outcome measures underwent narrative review. Study bias was assessed and reported using the Downs and Black checklist. Results A statistically significant difference of 0.39 points was found on the Tegner activity scale in favour of early surgery within 3 weeks (RR 0.39, CI 0.10, 0.67, p = 0.008). No statistically difference was found between groups for the patient-reported Lysholm score (RR − 0.18, CI − 2.40, 2.05, p = 0.17). There was no statistically significant difference between groups for intra-operative findings of meniscal lesions (RR 0.84, CI 0.66, 1.08, p = 0.17). A trend towards significance was observed for the incidence of chondral lesions in the early surgery group (RR 0.56, CI 0.31, 1.02, p = 0.06). All the studies were rated either fair or good on the Downs and Black checklist with no study excluded due to bias. Conclusions Although there was a statistically significant result for the Tegner activity scale in favour of early surgery, the magnitude of the effect is unlikely to translate into any clinically meaningful difference. At present, there remains no clear evidence to determine superiority of acute/early or delayed reconstruction of a ruptured anterior cruciate ligament. Further research through methodologically robust randomised controlled trials or through the UK National Ligament Registry may help to provide clearer guidance.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Early or delayed anterior cruciate ligament reconstruction: Is one superior? A systematic review and meta-analysis

Ferguson

Palmer

Khan

et al. 2019

Eur J Orthop Surg Traumatol

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“…occurrence of inflammation and further reduce the probability of knee osteoarthritis [8]. Many scholars believe that when ACL rupture occurs, ACL reconstruction should be given in time to reduce the occurrence of secondary meniscal injury, cartilage degenerative changes and chronic synovitis and other complications [9] [10] [11].…”

Section: Lysholm Score and Ikdc Scorementioning

confidence: 99%

Postoperative Therapeutic Effect of ACL Reconstruction at Different Periods

Ai¹,

Feng²,

Hu³

et al. 2019

IJCM

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Objective: To analyze postoperative therapeutic effects of patients with fractured anterior cruciate ligament (ACL) that underwent autologous tendon reconstruction at early and late period. Methods: A total of 60 patients underwent autologous tendon reconstruction were enrolled and retrospectively analyzed via arthroscopes from December, 2015 to December, 2017 in our hospital, in which 30 patients treated with ACL reconstruction within 6 weeks of injury were selected as the early reconstruction group (Group A), and the other 30 cases with ACL reconstruction between 6 weeks and 6 months were as late reconstruction group (Group B); the therapeutic effect of early and late ACL reconstruction was analyzed by recording and comparing of several indexes, such as knee lysholm score, knee IKDC score, intraoperative hemorrhage, operation time, pre-and post-operative range of motion (ROM) of the knee, etc. Results: The pre-and post-operative lysholm scores and IKDC scores were compared between the two groups, without statistically significant results (P > 0.05). The knee ROM scores of the late reconstruction group were higher than those of the early group (P < 0.05), and the intraoperative blood loss in the late stage was less than that in the early group (P < 0.05), which exhibits that the short-term clinical efficacy of early and late arthroscopic autologous tendon reconstruction for knee ACL injury was similar, but the late reconstruction group was with less intraoperative bleeding, and better postoperative joint mobility recovery; in conclusion, it is recommended that patients can be operated between 6 weeks and 6 months after injury.

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

Shen

Liu

et al. 2022

JAMA Netw Open

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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 &lt; .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.

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Functional outcome of an early anterior cruciate ligament reconstruction in comparison to delayed: Are we waiting in vain?

Abstract: There are no clinical differences in terms of range of motion and functional results between early and delayed ACLR.

Cited by 25 publications

References 20 publications

Early or delayed anterior cruciate ligament reconstruction: Is one superior? A systematic review and meta-analysis

Early or delayed anterior cruciate ligament reconstruction: Is one superior? A systematic review and meta-analysis

Postoperative Therapeutic Effect of ACL Reconstruction at Different Periods

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

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