Functional Outcome of an Early Anterior Cruciate Ligament Reconstruction in Comparison to Delayed: Are We Waiting in Vain?

Overview

Journal J Clin Orthop Trauma

Specialty Orthopedics

Date 2018 Jun 14

PMID 29896021

Citations 10

Authors

Rajeev Raj Manandhar

Karthik Chandrashekhar

Vinay Kumaraswamy

Santosh Sahanand

David Rajan

Affiliations

Soon will be listed here.

Abstract

Background: Surgical techniques of ACL reconstruction (ACLR) have evolved over the past three decades along with debate regarding timing of reconstruction. It was a widespread belief that the timing of surgery was an important factor in determining the resulting stiffness after ACLR. Delayed rather than early reconstruction of the ACL is the current recommended treatment since it is thought to give a better functional outcome. However, there is no consensus in the literature regarding the optimal time of surgical intervention. The purpose of this study was to compare the range of motion and functional outcome in patients who underwent ACLR early with those that were delayed.

Materials And Methods: The patients were randomized into two groups; patients who underwent the procedure within three weeks were kept in Group I (Early) and those patients who were reconstructed after six weeks were categorized as Group II (Delayed). Hamstring grafts were used and a standard protocol of surgery and physiotherapy was followed. The range of motion, IKDC and Tegner scores were compared.

Results: A hundred and four patients underwent ACLR; fifty-three patients were grouped as Group I (Early) and fifty one as Group II (Delayed). The range of motion of both groups was comparable. The IKDC and Tegner scores were also comparable for early (Group I) ACLR and the patients who had their ACL reconstructed after a delay of at least 6 weeks (Group II).

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

Citing Articles

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Delayed anterior cruciate ligament reconstruction and risk of meniscus injury: Exploring the safest delay interval.

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Impact of Surgical Timing on Functional Outcomes after Anterior Cruciate Ligament Reconstruction.

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Optimal Timing of Anterior Cruciate Ligament Reconstruction in Patients With Anterior Cruciate Ligament Tear: A Systematic Review and Meta-analysis.

Shen X, Liu T, Xu S, Chen B, Tang X, Xiao J JAMA Netw Open. 2022; 5(11):e2242742.

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References

Meighan A, Keating J, Will E . 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(4):521-4. DOI: 10.1302/0301-620x.85b4.13743. View

Mayr H, Weig T, Plitz W . Arthrofibrosis following ACL reconstruction--reasons and outcome. Arch Orthop Trauma Surg. 2004; 124(8):518-22. DOI: 10.1007/s00402-004-0718-x. View

Clayton R, Court-Brown C . The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury. 2008; 39(12):1338-44. DOI: 10.1016/j.injury.2008.06.021. View

Raviraj A, Anand A, Kodikal G, Chandrashekar M, Pai S . A comparison of early and delayed arthroscopically-assisted reconstruction of the anterior cruciate ligament using hamstring autograft. J Bone Joint Surg Br. 2010; 92(4):521-6. DOI: 10.1302/0301-620X.92B4.22973. View

HUNTER R, Mastrangelo J, Freeman J, Purnell M, Jones R . The impact of surgical timing on postoperative motion and stability following anterior cruciate ligament reconstruction. Arthroscopy. 1996; 12(6):667-74. DOI: 10.1016/s0749-8063(96)90168-1. View

Granan L, Bahr R, Lie S, Engebretsen L . 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(5):955-61. DOI: 10.1177/0363546508330136. View

Mohtadi N, Webster-Bogaert S, Fowler P . Limitation of motion following anterior cruciate ligament reconstruction. A case-control study. Am J Sports Med. 1991; 19(6):620-4; discussion 624-5. DOI: 10.1177/036354659101900612. View

Smith T, Davies L, Hing C . Early versus delayed surgery for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2009; 18(3):304-11. DOI: 10.1007/s00167-009-0965-z. View

Beynnon B, Johnson R, Abate J, Fleming B, Nichols C . Treatment of anterior cruciate ligament injuries, part I. Am J Sports Med. 2005; 33(10):1579-602. DOI: 10.1177/0363546505279913. View

10.

Amis A, Dawkins G . Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br. 1991; 73(2):260-7. DOI: 10.1302/0301-620X.73B2.2005151. View

11.

Jomha N, Borton D, Clingeleffer A, Pinczewski L . Long-term osteoarthritic changes in anterior cruciate ligament reconstructed knees. Clin Orthop Relat Res. 1999; (358):188-93. View

12.

Magit D, Wolff A, Sutton K, Medvecky M . Arthrofibrosis of the knee. J Am Acad Orthop Surg. 2007; 15(11):682-94. DOI: 10.5435/00124635-200711000-00007. View

13.

Almekinders L, Moore T, Freedman D, Taft T . Post-operative problems following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 1995; 3(2):78-82. DOI: 10.1007/BF01552379. View

14.

Shelbourne K, Wilckens J, Mollabashy A, Decarlo M . Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Am J Sports Med. 1991; 19(4):332-6. DOI: 10.1177/036354659101900402. View

15.

Iyyampillai G, Raman E, Rajan D, Krishnamoorthy A, Sahanand S . Determinants of Femoral Tunnel Length in Anterior Cruciate Ligament Reconstruction: CT Analysis of the Influence of Tunnel Orientation on the Length. Knee Surg Relat Res. 2013; 25(4):207-14. PMC: 3867614. DOI: 10.5792/ksrr.2013.25.4.207. View

16.

Bottoni C, Liddell T, Trainor T, Freccero D, Lindell K . Postoperative range of motion following anterior cruciate ligament reconstruction using autograft hamstrings: a prospective, randomized clinical trial of early versus delayed reconstructions. Am J Sports Med. 2008; 36(4):656-62. DOI: 10.1177/0363546507312164. View

17.

Brambilla L, Pulici L, Carimati G, Quaglia A, Prospero E, Bait C . Prevalence of Associated Lesions in Anterior Cruciate Ligament Reconstruction: Correlation With Surgical Timing and With Patient Age, Sex, and Body Mass Index. Am J Sports Med. 2015; 43(12):2966-73. DOI: 10.1177/0363546515608483. View

18.

Francis A, Thomas R, McGregor A . Anterior cruciate ligament rupture: reconstruction surgery and rehabilitation. A nation-wide survey of current practice. Knee. 2001; 8(1):13-8. DOI: 10.1016/s0968-0160(00)00073-9. View

19.

Kwok C, Harrison T, Servant C . The optimal timing for anterior cruciate ligament reconstruction with respect to the risk of postoperative stiffness. Arthroscopy. 2013; 29(3):556-65. DOI: 10.1016/j.arthro.2012.09.005. View