Timing of surgery for knee injuries may not affect outcomes

The optimal timing of surgical repair or reconstruction has not yet been definitively established, according to a study published in the Dec. 2009 issue of The Journal of Bone and Joint Surgery.

The study, conducted by researchers at the Department of Orthopaedic Surgery at the University of Virginia in Charlottesville, found that patients who underwent surgery more than 3 weeks after a multiple-ligament knee injury — a chronic intervention treatment — may have comparable outcomes, in regard to knee stability, to those who undergo surgery within 3 weeks of injury — an acute intervention treatment.

Researchers also found that early mobility is associated with better outcomes than immobilization in patients who are treated within a 3-week time period.

“After a review of the available literature, we found that chronic intervention provides results that are at least as good as acute intervention, despite some recent studies showing that acute intervention may be better,” stated lead author William R. Mook, MD, in a press release. “The reasons for this are not clear.”

Mook and his team analyzed 24 retrospective studies, looking at 396 knees treated surgically for the most severe multiple-ligament knee injuries. Patients were managed acutely, chronically, or with a combination of both interventions — a staged treatment. The advantages and disadvantages of mobilization were also studied.

Patients who received acute intervention had less stable knees and were not able to bend their knees as far as those who were treated with chronic intervention. Furthermore, patients who underwent staged procedures reported better outcomes than those treated just early or late.

Researchers stated the literature review suggests that surgical reconstructions within 3 weeks of the injury provide knee stability comparable to that found in patients who undergo reconstruction later. For patients treated within 3 weeks, early mobility — compared to immobilization — is associated with better outcomes. Early surgery, however, is highly associated with range of motion limitations.

According to the release, patients reported better outcomes and fewer range of motion limitations with a combination of acute and chronic procedures, though additional treatment for joint stiffness may be required in these patients. Those treated through more aggressive rehabilitation within 3 weeks of their injury may experience no need for additional joint stiffness treatment.

"Although recent evidence suggests that acute intervention is superior to chronic interventions in all outcomes, we found that chronic intervention may provide knees with equal stability as those managed acutely," Mook concluded.