Similar clinical results found with acute vs. delayed ACL reconstruction

However, the investigators do not recommend acute treatment for all acute tears.

CALGARY, Alberta — Citing a potential a loss of motion, some surgeons have advocated delayed reconstruction over early reconstruction of acute ACL tears. However, new research indicates that comparable clinical outcomes are possible regardless of the timing of surgery, according to a surgeon speaking here.

"Comparable postoperative range of motion and stability can be achieved following early ACL reconstruction performed with autograft hamstring, as we have done. [Delaying] the surgery in patients with an acute ACL [tear] is not required, as long as the extension and early range of motion are a factor [in the rehabilitation protocol]," said Craig R. Bottoni, MD, at the American Orthopaedic Society for Sports Medicine 2007 Annual Meeting.

Bottoni and colleagues conducted a prospective, randomized study of 69 patients with acute ACL tears treated with either delayed or early reconstruction.

The acute reconstruction group included 34 patients treated at an average of 9 days postinjury. The delayed reconstruction group included 35 patients treated at an average of 85 days after injury.

Patients in both groups averaged 27 years of age, had similar demographic profiles, underwent the same surgical reconstruction technique and followed the same postoperative rehabilitation protocol.

The researchers found no statistically significant differences between the groups regarding postop range of motion and stability at 1 year mean follow-up. Patients in the early reconstruction group, however, returned to full activity 1 to 3 months earlier than those in the delayed surgery group, Bottoni said.

"However, although we concluded ... that there were no deleterious effects [from] performing an ACL reconstruction acutely, we do not recommend that all ACL reconstructions should be performed acutely," Bottoni noted.

"In fact, in many cases there may be an overriding benefit to delaying the surgery, an important point that we want to emphasize," he said.

"[We] found that early ACL reconstructions do not result in loss of motion or suboptimal clinical results as long as a rehabilitation protocol emphasizing extension and early range of motion is employed," the authors said in the study abstract.

For more information:
Craig R. Bottoni, MD, can be reached at OrthoSports of Clearwater, 3251 McMullen Booth Road, Suite 201, Clearwater, FL 33761; (727) 725-6231; e-mail: cbottoni@orthosports.com.
Bottoni CR, Liddell TR, Trinor TJ, et al. Timing of surgery for anterior cruciate ligament injuries: A prospective, randomized clinical trial of early versus delayed reconstructions. Presented at Presented at the American Orthopaedic Society for Sports Medicine 2007 Annual Meeting. July 12-15, 2007. Calgary, Alberta.