Acute Anterior Cruciate Ligament Reconstruction Performed Within 10 Days of Injury Does Not Increase Risk of Postoperative Arthrofibrosis: A Systematic Review and Meta-analysis

• Published in: The American journal of sports medicine 2024-06, Vol.52 (7), p.1888-1896
• Main Authors: Aman, Zachary S., Blaber, Olivia K., R. McDermott, Emily, DeFoor, Mikalyn T., DePhillipo, Nicholas N., Dickens, Jonathan F., Dekker, Travis J.
• Format: Article
• Language: English
• Subjects: Anterior Cruciate Ligament Injuries - surgery; Anterior Cruciate Ligament Reconstruction - adverse effects; Clinical outcomes; Fibrosis; Humans; Joint and ligament injuries; Meta-analysis; Patients; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Quantitative analysis; Range of Motion, Articular; Reoperation - statistics & numerical data; Systematic review; Time-to-Treatment
• ISSN: 0363-5465; 1552-3365; 1552-3365
• DOI: 10.1177/03635465231192987

Background: The optimal timing of anterior cruciate ligament (ACL) reconstruction (ACLR) remains a controversial topic. Previous reviews have demonstrated that there are no differences between early and delayed ACLR; however, these studies have been limited by heterogeneous definitions of acute ACL injury. Purpose: To evaluate postoperative patient functional outcomes and risk for arthrofibrosis after acute arthroscopic ACLR performed ≤10 days after injury. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using multiple medical databases. Inclusion criteria were studies that evaluated postoperative range of motion outcomes for patients undergoing ACLR ≤10 days after initial ACL injury. For included comparative studies comparing patient groups undergoing ACLR ≤10 days and patients undergoing “delayed” ACLR after ≥3 weeks of initial injury, quantitative analysis was performed to assess for differences in postoperative arthrofibrosis, reoperation rates, and patient-reported outcomes between groups. DerSimonian-Laird binary random-effects models were constructed to quantitatively describe the association between the ACLR time period and patient outcomes by generating effect estimates in the form of odds ratios with 95% CIs. Qualitative analysis was performed to describe variably reported patient outcomes and the risk of arthrofibrosis after ACLR for noncomparative studies. Results: Screening yielded 6 full-text articles with 448 patients who underwent ACLR (296 ACLR 3 weeks), with a pooled mean age of 28.1 years. For studies amenable to quantitative analysis, there were no significant differences between ACLR performed ≤10 days and ACLR performed at the 3-week point or after in terms of postoperative stiffness (3 studies; odds ratio, 1.27; P = .508), Tegner scores (2 studies; mean difference, –0.056; P = .155), or reoperation for stiffness (3 studies; odds ratio, 0.869; P = .462). The overall incidence of postoperative arthrofibrosis after 12 months of follow-up was 11 of 296 (3.7%) for ACLRs performed ≤10 days versus 6 of 152 (3.9%) for those performed at the 3-week point or after. Conclusion: ACLR performed ≤10 days after the inciting injury does not increase the risk of postoperative arthrofibrosis and demonstrates similar patient-reported outcomes compared with ACLR performed at the 3-week