Subacute versus delayed reconstruction of the anterior cruciate ligament in the competitive athlete

Abstract

The objective of this study was to compare the function and activity level in patients with anterior cruciate ligament injuries, who participated in competitive sports (Tegner activity level ≥ 7) and underwent a reconstruction of the anterior cruciate ligament, either subacute (2–12 weeks, group I) or late (12–24 months, group II) after the injury. The patients in group I (n = 97) were comparable with those in group II (n = 103) in terms of gender, age, pre-injury activity level, and the reconstruction technique. At the final follow-up (2–5.5 years after the operation), the Lysholm score, the IKDC evaluation system and the one-leg-hop test revealed no differences between the groups. There were also no differences between the groups in terms of the patients’ subjective evaluation or expectations. The Tegner activity level at follow-up was 8 (range 2–10) in group I and 6 (range 2–9) in group II (P = 0.0001). The same thing was found in terms of the desired Tegner activity level, which was 9 (range 4–9) in group I and 7 (range 3–10) in group II (P = 0.0002). The KT-1000 laxity meter revealed a total side-to-side difference of 1.5 mm (–3.5–8.5) in group I and 1.5 mm (–3.5–7) in group II (NS). Associated meniscal surgery between the index injury and the reconstruction, or during the reconstruction, was performed in 37/97 (38%) of the patients in group I and 59/103 (57%) of the patients in group II (P < 0.01). This study revealed that competitive athletes who underwent reconstruction at a subacute stage after the anterior cruciate ligament injury had a higher activity level 2–5.5 years after the index operation, as well as a higher desired level of activity compared to athletes who had the reconstruction delayed by 12–24 months. Furthermore, meniscal injuries were significantly more frequent if the reconstruction was delayed.