Efficacy and Safety of Early Versus Delayed Reconstruction for Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis

Abstract

Abstract Background: The selection of early and delayed anterior cruciate ligament reconstruction (ACLR) remains a controversial issue in the management of anterior cruciate ligament (ACL) injuries. The purpose of this study was to critically evaluate the efficacy and safety of early versus delayed ACLR for ACL injuries based on the different cut-off values of the timing of operation. Methods:PubMed, Medline, Embase, Cochrane library, China National Knowledge Infrastructure, Chinese Biomedical Literature, and Wanfang Digital Periodical database were searched from inception to October 2022 without language restrictions. Randomized controlled trials (RCTs) and cohort studies (CSs) comparing early ACLR and delayed ACLR for ACL injuries were included. Results:Twenty-four studies (10 RCTs and 14 CSs) were included. According to the information from included studies, 3 weeks, 4 weeks, 6 weeks, 6 months, and 12 months after ACL injuries were considered as the cut-off values of early and delayed ACLR respectively. The results of CSs showed that early ACLR performed within 4 weeks or 12 months after ACL injuries could significantly improve the Lysholm score and VAS score at 6 and 12 months postoperatively and decrease the incidence of adverse events compared with delayed ACLR (P < 0.05). Our meta-analysis involving RCTs or CSs showed that early ACLR performed within 3 weeks, 4 weeks, 6 weeks, 6 months or 12 months after ACL injuries could significantly increase the IKDC score at 6 and 12 months postoperatively compared with delayed ACLR (P < 0.05). However, no statistically significant difference in the positive rate of Lachman test and incidence of meniscus injuries and chondral lesions between two groups when 3 weeks, 6 weeks, 6 months or 12 months after ACL injuries were considered as the cut-off values of early and delayed ACLR (P > 0.05). Conclusion: The present study suggests that early ACLR performed within 4 weeks after ACL injuries may be more effective for improving the knee function and relieving the pain compared to delayed ACLR. More high-quality studies are still warranted.