Impact of Surgical Timing on Clinical Outcomes in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autografts

Abstract

Background:To date, no studies have analyzed the influence on clinical outcomes of the interval between an anterior cruciate ligament (ACL) injury and double-bundle (DB) reconstruction with hamstring tendon autografts.Hypotheses:(1) Performing ACL reconstruction sooner after an injury will reduce postoperative anterior and rotatory knee instability, (2) postoperative range of knee motion or functional results will not be affected by different intervals between injury and surgery, and (3) preoperative isokinetic peak torque of the quadriceps and hamstring muscles will be lower in patients undergoing surgery earlier, while postoperative muscle strength will not be affected by surgery timing.Study Design:Cohort study; Level of evidence, 3.Methods:This study was conducted on a total of 171 patients who had undergone anatomic DB ACL reconstruction with hamstring tendon autografts. The patients were divided into 3 groups based on the time to surgery: (1) ≤1 month after the injury (group E; n = 25), (2) between 1 and 3 months after the injury (group M; n = 72), and (3) >3 months after the injury (group D; n = 74). Patients were assessed for a minimum of 2 years after surgery.Results:Concerning postoperative anterior laxity, 1-way analysis of variance demonstrated a significant difference (P = .0274) among the 3 groups. Anterior laxity was significantly less in group E than in group D (P = .0206). Spearman rank correlation analysis showed a significant correlation (ρ = 0.200; P = .0327) between anterior knee laxity and time to surgery. Also, a significant correlation (P = .0461) was found between the degree of the pivot-shift phenomenon and time to surgery. There were no significant differences in loss of knee extension or flexion among the 3 groups, nor were there any differences in the Lysholm knee score or International Knee Documentation Committee grade. Postoperatively, there were no significant differences in peak torque of the quadriceps or hamstring muscles among the 3 groups.Conclusion:Early DB reconstruction led to significantly less anterior laxity compared with delayed reconstruction. There were no significant differences in postoperative range of knee motion or functional results among the 3 time intervals between injury and surgery in this study.

Early and Delayed Surgery for Isolated ACL and Multiligamentous Knee Injuries Have Equivalent Results: A Systematic Review and Meta-analysis

“…4,36,39,43,55 Four studies were level 2 prospective studies, 6,8,23,26 whereas 7 were level 3 retrospective studies. 1,2,18,25,29,42,49 Regarding methodological quality, the 5 RCTs scored 5.4 of 10 points per the PEDro scale, representing 54% of the maximum points possible (Table 2).…”

Risk Factors of Loss of Knee Range of Motion after Primary Anterior Cruciate Ligament Reconstruction following Preoperative Recovery of Knee Range of Motion

“…4 Following this recommendation by Shelbourne et al, many researchers have evaluated the effect of surgical timing on the clinical outcomes and loss of ROM after ACLR. [5][6][7][8] According to a recent meta-analysis, 7 early ACLR results in similar clinical and stability outcomes to delayed ACLR. The timing of surgery may be an important factor associated with surgical outcomes; however, most previous studies did not report on whether or not preoperative loss of knee ROM existed, indicating that previous studies did not consider the influence of loss of knee ROM on the results or complications after ACLR.…”

“…Many previous studies have discussed the association between the timing of ACLR and surgical outcomes. [5][6][7][8] The timing of ACLR has been one of important issues for knee surgeons; however, surgical and postoperative factors are as pivotal as preoperative factors for evaluating surgical outcomes after ACLR. Few studies have considered the influence of preoperative knee ROM on the surgical outcomes.…”

Association Between Early Postoperative Graft Signal Intensity and Residual Knee Laxity After Anterior Cruciate Ligament Reconstruction

“… 35 , 41 Despite several advantages of anatomic ACLR, some patients still have the potential to develop residual knee laxity and experience unsuccessful clinical outcomes. 3 , 6 , 28 , 31 , 40 …”

“…35,41 Despite several advantages of anatomic ACLR, some patients still have the potential to develop residual knee laxity and experience unsuccessful clinical outcomes. 3,6,28,31,40 The early identification and adequate evaluation of those at risk of ACL graft failure could improve outcomes and eventually reduce the failure risk if surgeons can decide on suitable rehabilitation protocols and the appropriate timing of return to sports based on the condition of the reconstructed graft over time. Therefore, potential biomarkers such as blood samples and imaging studies would be useful to determine the risk of postoperative graft failure or residual knee laxity after anatomic ACLR as early as possible.…”