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Impact of surgical timing on the outcome of anterior cruciate ligament reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of the present study is the comparison of acute ACL reconstruction with or without meniscus repair within 48 h after injury and a delayed surgery during the inflammation-free interval. It was hypothesized that acute ACL reconstruction results in inferior patient reported outcomes and higher frequency of range of motion deficits.

Methods

The effect of acute (within 48 h) and delayed (during the inflammation-free interval) ACL surgery was prospectively studied on 160 consecutive patients with ACL injury between January 2010 and December 2011. Subgroup analyses were performed to evaluate patients with an additional meniscus repair separately from isolated ACL surgeries. During the study period, partial meniscectomies were recorded to evaluate time dependent meniscus reparability. Patient reported outcomes, objective IKDC and manual stability measurements were documented during the 24-month follow-up period. The Pearson Chi-squared test was used to evaluate objective outcome measures. The Mann–Whitney U test was performed to analyse the results of patient reported outcomes. Statistical significance was set at p < 0.05.

Results

For patients who underwent isolated ACL reconstruction, no statistical significant difference was observed at any time point regarding objective and subjective outcome measures. Significantly fewer patients who underwent acute combined ACL reconstruction and meniscus repair had an extension deficit between 3° and 5° at 12 months following surgery (3.7 vs. 22.2 %, p < 0.05). No difference regarding cyclops removal, re-injury of ACL or meniscus was found between the two surgical timing groups. Further, surgical timing did not influence the reparability of the meniscus.

Conclusion

An acute ACL reconstruction within 48 h is preferable in highly active patients or competitive athletes.

Level of evidence

Prospective cohort study, Level II.

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References

  1. Ahlen M, Liden M (2011) 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 19(3):488–494

    Article  PubMed  Google Scholar 

  2. Anderson AF, Anderson CN (2015) Correlation of meniscal and articular cartilage injuries in children and adolescents with timing of anterior cruciate ligament reconstruction. Am J Sports Med 43(2):275–281

    Article  PubMed  Google Scholar 

  3. Anstey DE, Heyworth BE, Price MD, Gill TJ (2012) Effect of timing of ACL reconstruction in surgery and development of meniscal and chondral lesions. Phys Sportsmed 40(1):36–40

    Article  PubMed  Google Scholar 

  4. Berbig R, Rillmann P (2000) Timing of the surgery of rupture of the anterior cruciate ligament. Effects of acute or delayed surgery on arthrofibrosis rate and work disability. Unfallchirurg 103(9):726–730

    Article  CAS  PubMed  Google Scholar 

  5. Bigoni M, Sacerdote P, Turati M, Franchi S, Gandolla M, Gaddi D, Moretti S, Munegato D, Augusti CA, Bresciani E, Omeljaniuk RJ, Locatelli V, Torsello A (2013) Acute and late changes in intraarticular cytokine levels following anterior cruciate ligament injury. J Orthop Res 31(2):315–321

    Article  CAS  PubMed  Google Scholar 

  6. Bottoni CR, Liddell TR, Trainor TJ, Freccero DM, Lindell KK (2008) 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 36(4):656–662

    Article  PubMed  Google Scholar 

  7. Brambilla L, Pulici L, Carimati G, Quaglia A, Prospero E, Bait C, Morenghi E, Portinaro N, Denti M, Volpi P (2015) 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 43(12):2966–2973

    Article  PubMed  Google Scholar 

  8. Church S, Keating JF (2005) Reconstruction of the anterior cruciate ligament: timing of surgery and the incidence of meniscal tears and degenerative change. J Bone Joint Surg Br 87(12):1639–1642

    Article  CAS  PubMed  Google Scholar 

  9. Cuellar VG, Cuellar JM, Golish SR, Yeomans DC, Scuderi GJ (2010) Cytokine profiling in acute anterior cruciate ligament injury. Arthroscopy 26(10):1296–1301

    Article  PubMed  Google Scholar 

  10. Flint JH, Wade AM, Giuliani J, Rue JP (2014) Defining the terms acute and chronic in orthopaedic sports injuries: a systematic review. Am J Sports Med 42(1):235–241

    Article  PubMed  Google Scholar 

  11. Gabler CM, Jacobs CA, Howard JS, Mattacola CG, Johnson DL (2015) Comparison of graft failure rate between autografts placed via an anatomic anterior cruciate ligament reconstruction technique: a systematic review, meta-analysis, and meta-regression. Am J Sports Med 44(4):1069–1079

    Article  PubMed  Google Scholar 

  12. Granan LP, Bahr R, Lie SA, Engebretsen L (2009) 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 37(5):955–961

    Article  PubMed  Google Scholar 

  13. Guenther ZD, Swami V, Dhillon SS, Jaremko JL (2014) Meniscal injury after adolescent anterior cruciate ligament injury: how long are patients at risk? Clin Orthop Relat Res 472(3):990–997

    Article  PubMed  Google Scholar 

  14. Harner CD, Irrgang JJ, Paul J, Dearwater S, Fu FH (1992) Loss of motion after anterior cruciate ligament reconstruction. Am J Sports Med 20(5):499–506

    Article  CAS  PubMed  Google Scholar 

  15. Haslauer CM, Proffen BL, Johnson VM, Hill A, Murray MM (2014) Gene expression of catabolic inflammatory cytokines peak before anabolic inflammatory cytokines after ACL injury in a preclinical model. J Inflamm (Lond) 11(1):34. doi:10.1186/s12950-014-0034-3

    Article  PubMed Central  Google Scholar 

  16. Herbst E, Hoser C, Hildebrandt C, Raschner C, Hepperger C, Pointner H, Fink C (2015) Functional assessments for decision-making regarding return to sports following ACL reconstruction. Part II: clinical application of a new test battery. Knee Surg Sports Traumatol Arthrosc 23(5):1283–1291

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Hildebrandt C, Muller L, Zisch B, Huber R, Fink C, Raschner C (2015) Functional assessments for decision-making regarding return to sports following ACL reconstruction. Part I: development of a new test battery. Knee Surg Sports Traumatol Arthrosc 23(5):1273–1281

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hunter RE, Mastrangelo J, Freeman JR, Purnell ML, Jones RH (1996) The impact of surgical timing on postoperative motion and stability following anterior cruciate ligament reconstruction. Arthroscopy 12(6):667–674

    Article  CAS  PubMed  Google Scholar 

  19. Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH (2012) Individualized anterior cruciate ligament surgery: a prospective study comparing anatomic single- and double-bundle reconstruction. Am J Sports Med 40(8):1781–1788

    Article  PubMed  Google Scholar 

  20. Irie K, Uchiyama E, Iwaso H (2003) Intraarticular inflammatory cytokines in acute anterior cruciate ligament injured knee. Knee 10(1):93–96

    Article  PubMed  Google Scholar 

  21. Kaeding CC, Pedroza AD, Reinke EK, Huston LJ, Consortium M, Spindler KP (2015) Risk factors and predictors of subsequent ACL injury in either knee after ACL reconstruction: prospective analysis of 2488 primary ACL reconstructions from the MOON cohort. Am J Sports Med 43(7):1583–1590

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kennedy J, Jackson MP, O’Kelly P, Moran R (2010) Timing of reconstruction of the anterior cruciate ligament in athletes and the incidence of secondary pathology within the knee. J Bone Joint Surg Br 92(3):362–366

    Article  CAS  PubMed  Google Scholar 

  23. Krutsch W, Zellner J, Baumann F, Pfeifer C, Nerlich M, Angele P (2015) Timing of anterior cruciate ligament reconstruction within the first year after trauma and its influence on treatment of cartilage and meniscus pathology. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3830-2

    PubMed  Google Scholar 

  24. Kwok CS, Harrison T, Servant C (2013) The optimal timing for anterior cruciate ligament reconstruction with respect to the risk of postoperative stiffness. Arthroscopy 29(3):556–565

    Article  PubMed  Google Scholar 

  25. Laible C, Stein DA, Kiridly DN (2013) Meniscal repair. J Am Acad Orthop Surg 21(4):204–213

    Article  PubMed  Google Scholar 

  26. Lyman S, Hidaka C, Valdez AS, Hetsroni I, Pan TJ, Do H, Dunn WR, Marx RG (2013) Risk factors for meniscectomy after meniscal repair. Am J Sports Med 41(12):2772–2778

    Article  PubMed  Google Scholar 

  27. Maak TG, Fabricant PD, Wickiewicz TL (2012) Indications for meniscus repair. Clin Sports Med 31(1):1–14

    Article  PubMed  Google Scholar 

  28. Magit D, Wolff A, Sutton K, Medvecky MJ (2007) Arthrofibrosis of the knee. J Am Acad Orthop Surg 15(11):682–694

    Article  PubMed  Google Scholar 

  29. Mather RC 3rd, Hettrich CM, Dunn WR, Cole BJ, Bach BR Jr, Huston LJ, Reinke EK, Spindler KP (2014) Cost-effectiveness analysis of early reconstruction versus rehabilitation and delayed reconstruction for anterior cruciate ligament tears. Am J Sports Med 42(7):1583–1591

    Article  PubMed  PubMed Central  Google Scholar 

  30. Mayr HO, Weig TG, Plitz W (2004) Arthrofibrosis following ACL reconstruction–reasons and outcome. Arch Orthop Trauma Surg 124(8):518–522

    Article  PubMed  Google Scholar 

  31. Meighan AA, Keating JF, Will E (2003) Outcome after reconstruction of the anterior cruciate ligament in athletic patients. A comparison of early versus delayed surgery. J Bone Joint Surg Br 85(4):521–524

    Article  CAS  PubMed  Google Scholar 

  32. Mordecai SC, Al-Hadithy N, Ware HE, Gupte CM (2014) Treatment of meniscal tears: an evidence based approach. World J Orthop 5(3):233–241

    Article  PubMed  PubMed Central  Google Scholar 

  33. Newman JT, Carry PM, Terhune EB, Spruiell MD, Heare A, Mayo M, Vidal AF (2015) Factors predictive of concomitant injuries among children and adolescents undergoing anterior cruciate ligament surgery. Am J Sports Med 43(2):282–288

    Article  PubMed  Google Scholar 

  34. Papastergiou SG, Koukoulias NE, Mikalef P, Ziogas E, Voulgaropoulos H (2007) Meniscal tears in the ACL-deficient knee: correlation between meniscal tears and the timing of ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 15(12):1438–1444

    Article  PubMed  Google Scholar 

  35. Passler JM, Schippinger G, Schweighofer F, Fellinger M, Seibert FJ (1995) Complications in 283 cruciate ligament replacement operations with free patellar tendon transplantation. Modification by surgical technique and surgery timing. Unfallchirurgie 21(5):240–246

    Article  CAS  PubMed  Google Scholar 

  36. Robertson GA, Coleman SG, Keating JF (2009) Knee stiffness following anterior cruciate ligament reconstruction: the incidence and associated factors of knee stiffness following anterior cruciate ligament reconstruction. Knee 16(4):245–247

    Article  CAS  PubMed  Google Scholar 

  37. Saltzman BM, Cvetanovich GL, Nwachukwu BU, Mall NA, Bush-Joseph CA, Bach BR Jr (2015) Economic analyses in anterior cruciate ligament reconstruction: a qualitative and systematic review. Am J Sports Med 44(5):1329–1335

    Article  PubMed  Google Scholar 

  38. Shelbourne KD, Patel DV (1995) Timing of surgery in anterior cruciate ligament-injured knees. Knee Surg Sports Traumatol Arthrosc 3(3):148–156

    Article  CAS  PubMed  Google Scholar 

  39. Shelbourne KD, Wilckens JH, Mollabashy A, DeCarlo M (1991) Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Am J Sports Med 19(4):332–336

    Article  CAS  PubMed  Google Scholar 

  40. Sikka R, Kurtenbach C, Steubs JT, Boyd JL, Nelson BJ (2016) Anterior cruciate ligament injuries in professional hockey players. Am J Sports Med 44(2):378–383

    Article  PubMed  Google Scholar 

  41. Smith TO, Davies L, Hing CB (2010) Early versus delayed surgery for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 18(3):304–311

    Article  PubMed  Google Scholar 

  42. Starke C, Kopf S, Petersen W, Becker R (2009) Meniscal repair. Arthroscopy 25(9):1033–1044

    Article  PubMed  Google Scholar 

  43. Steadman JR, Matheny LM, Singleton SB, Johnson NS, Rodkey WG, Crespo B, Briggs KK (2015) Meniscus suture repair: minimum 10-year outcomes in patients younger than 40 years compared with patients 40 and older. Am J Sports Med 43(9):2222–2227

    Article  PubMed  Google Scholar 

  44. van Grinsven S, van Cingel RE, Holla CJ, van Loon CJ (2010) Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18(8):1128–1144

    Article  PubMed  Google Scholar 

  45. Wasilewski SA, Covall DJ, Cohen S (1993) Effect of surgical timing on recovery and associated injuries after anterior cruciate ligament reconstruction. Am J Sports Med 21(3):338–342

    Article  CAS  PubMed  Google Scholar 

  46. Webster KE, Feller JA, Leigh WB, Richmond AK (2014) Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction. Am J Sports Med 42(3):641–647

    Article  PubMed  Google Scholar 

  47. Westermann RW, Wright RW, Spindler KP, Huston LJ, Group MK, Wolf BR (2014) Meniscal repair with concurrent anterior cruciate ligament reconstruction: operative success and patient outcomes at 6-year follow-up. Am J Sports Med 42(9):2184–2192

    Article  PubMed  PubMed Central  Google Scholar 

  48. Yoo JC, Ahn JH, Lee SH, Yoon YC (2009) Increasing incidence of medial meniscal tears in nonoperatively treated anterior cruciate ligament insufficiency patients documented by serial magnetic resonance imaging studies. Am J Sports Med 37(8):1478–1483

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Elmar Herbst

  2. Gelenkpunkt, Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria

    Christian Hoser, Peter Gföller, Caroline Hepperger, Elisabeth Abermann & Christian Fink

  3. Research Unit for Orthopedic Sports Medicine and Injury Prevention, UMIT/ISAG, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria

    Caroline Hepperger & Christian Fink

  4. Department of Traumatology, Bezirkskrankenhaus St. Johann in Tirol, Bahnhofstraße 14, 6380, St. Johann in Tirol, Austria

    Katharina Neumayer

  5. Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA

    Volker Musahl

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  1. Elmar Herbst
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Correspondence to Christian Fink.

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Herbst, E., Hoser, C., Gföller, P. et al. Impact of surgical timing on the outcome of anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 25, 569–577 (2017). https://doi.org/10.1007/s00167-016-4291-y

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  • DOI: https://doi.org/10.1007/s00167-016-4291-y

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