Purpose
The aim of this meta-analysis was to compare the risk of stiffness between early and
delayed anterior cruciate ligament (ACL) surgery in studies that use a modern accelerated
rehabilitation protocol.
Methods
Medline, Embase, and the Cochrane library were searched for studies that compared
outcomes for early and delayed ACL reconstruction with a modern accelerated rehabilitation
protocol. Risk ratios for stiffness were pooled using random effects meta-analysis.
Results
A total of 8 studies were included in this review. The 3 randomized trials found no
difference in the risk of postoperative stiffness at cutoff points of <2, <3, and
<10 weeks between early surgery and delayed surgery. An analysis of the 7 studies
whose outcomes could be pooled revealed no significant increase in risk of adverse
outcomes with early surgery using a variety of cutoff points (1, 2, 10, 12, and 20
weeks). Sensitivity analysis of individual outcomes failed to show any significant
difference between early and delayed surgery with respect to arthrofibrosis, stiffness,
range of motion deficits, extension deficits, and flexion deficits.
Conclusions
If a modern surgical technique and an accelerated rehabilitation protocol are used,
there is no increased risk of knee stiffness if an ACL reconstruction is performed
as early as 1 week after injury.
Level of Evidence
Level II, meta-analysis of Level I and II studies.
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References
- Treatment of anterior cruciate ligament injuries: Part I.Am J Sports Med. 2005; 33: 1579-1602
- Arthrofibrosis of the knee.J Am Acad Orthop Surg. 2007; 15: 682-694
- Arthrofibrosis in acute anterior cruciate ligament reconstruction: The effect of timing of reconstruction and rehabilitation.Am J Sports Med. 1991; 19: 332-336
- Loss of motion after anterior cruciate ligament reconstruction.Am J Sports Med. 1992; 20: 499-506
- Outpatient surgical management of arthrofibrosis after anterior cruciate ligament surgery.Am J Sports Med. 1994; 22: 192-197
- Effect of surgical timing on recovery and associated injuries after anterior cruciate ligament reconstruction.Am J Sports Med. 1993; 21: 338-342
- Quality of life and clinical outcome after anterior cruciate ligament reconstruction using patellar tendon graft or quadrupled semitendinosus graft.Am J Sports Med. 2010; 38: 1533-1541
- Postoperative range of motion following anterior cruciate ligament reconstruction using autograft hamstrings: A prospective, randomized clinical trial of early versus delayed reconstruction.Am J Sports Med. 2008; 36: 656-662
- A randomized trial of treatment for acute anterior cruciate ligament tears.N Engl J Med. 2010; 363: 331-342
- Outcome after reconstruction of the anterior cruciate ligament in athletic patients–a comparison of early versus delayed surgery.J Bone Joint Surg Br. 2003; 85: 521-524
- A comparison of early and delayed arthroscopically-assisted reconstruction of the anterior cruciate ligament using hamstring autograft.J Bone Joint Surg Br. 2010; 92: 521-526
- Early versus delayed surgery for anterior cruciate ligament reconstruction: A systematic review and meta-analysis.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 304-311
- Are meniscus and cartilage injuries related to time to anterior cruciate ligament reconstruction?.Am J Sports Med. 2011; 39: 1894-1899
- Reconstruction of the anterior cruciate ligament: timing of surgery and the incidence of meniscal tears and degenerative change.J Bone Joint Surg Br. 2005; 87: 1639-1642
- Timing of anterior cruciate ligament reconstructive surgery and risk of cartilage lesions and meniscal tears: A cohort study based on the Norwegian National Knee Ligament Registry.Am J Sports Med. 2009; 37: 955-961
- Long-term osteoarthritic changes in anterior cruciate ligament reconstructed knees.Clin Orthop Relat Res. 1999; 358: 188-193
- The evaluation of intraarticular lesions accompanying ACL ruptures in military personnel who elected not to restrict their daily activities: The effect of age and time from injury.Knee Surg Sports Traumatol Arthrosc. 2009; 14: 1139-1147
- Accelerated versus nonaccelerated rehabilitation after anterior cruciate ligament reconstruction: A prospective, randomized, double-blind investigation evaluating knee joint laxity using roentgen stereophotogrammetric analysis.Am J Sports Med. 2011; 39: 2536-2548
- Evidence-based rehabilitation following anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1128-1144
- Evaluation of knee ligament injuries with the IKDC form.Knee Surg Sports Traumatol Arthrosc. 1993; 1: 226-234
- Studies of surgical outcome after patellar tendinopathy: Clinical significance of methodological deficiencies and guidelines for future studies.Scand J Med Sci Sports. 2000; 10: 2-11
- Management of combined ACL–MCL tears: A systematic review.Br Med Bull. 2010; 93: 201-215
- The appropriateness of asymmetry tests for publication bias in meta-analyses: A large survey.CMA J. 2007; 176: 1091-1096
- Measuring inconsistency in meta-analyses.BMJ. 2003; 327: 557-560
- A comparison of the clinical outcome after anterior cruciate ligament reconstruction using a hamstring tendon autograft with special emphasis on the timing of the reconstruction.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 488-494
- The impact of surgical timing on postoperative motion and stability following anterior cruciate ligament reconstruction.Arthroscopy. 1996; 12: 667-674
- Subacute versus delayed reconstruction of the anterior cruciate ligament in the competitive athlete.Knee Surg Sprots Traumatol Arthosc. 1999; 7: 146-151
- A comparison of results in acute and chronic anterior cruciate ligament ruptures of arthoscopically assisted autogenous patellar tendon reconstruction.Am J Sports Med. 1997; 25: 460-471
- Prompt operative intervention reduces long-term osteoarthritis after knee anterior cruciate ligament tear.Arthroscopy. 2011; 27: 149-152
- Timing of surgery in anterior cruciate ligament-injured knees.Knee Surg Sports Traumatol Arthrosc. 1995; 3: 148-156
Article info
Publication history
Published online: January 14, 2013
Accepted:
September 9,
2012
Received:
July 17,
2012
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
