Background:

After anterior cruciate ligament (ACL) injury, the optimal timing of ACL reconstruction and the influence of this timing on chondral damage remain unclear.

Purpose:

To assess the effect of timing of ACL reconstruction on the presence of chondral injuries via a systematic review and meta-analysis.

Study Design:

Systematic review and meta-analysis; Level of evidence, 4.

Methods:

Two reviewers independently performed systematic literature searches of 5 online databases using the Cochrane methodology for systematic reviews. Eligibility criteria were any comparative study of patients aged >16 years that assessed the relationship between timing of primary ACL reconstruction surgery and rates of chondral injuries. Meta-analysis was conducted using a random-effects model.

Results:

After screening, 14 studies (n = 3559 patients) out of 2363 titles met the inclusion criteria: 3 randomized controlled trials (n = 272), 3 prospective cohort studies (n = 398), and 8 retrospective cohort studies (n = 2889). In analysis of the studies, chondral injury rates were compared between ACL reconstructions performed before and after 3 time points: 3, 6, and 12 months after injury (eg, ≤3 vs >3 months). The rates of chondral injury increased with each time point. The increase was mostly due to low-grade injuries at 3 months (estimated odds ratio, 1.914; 95% CI, 1.242-2.949; P = .003), with the increase in high-grade injuries becoming predominant after 12 months (estimated odds ratio, 3.057; 95% CI, 1.460-6.40; P = .003).

Conclusion:

Our findings suggest that delaying ACL reconstruction surgery results in a higher rate of chondral injuries and the severity of these lesions worsens with time. These findings are comparable with those of our previously published study, which demonstrated a higher risk of meniscal tears associated with delayed ACL surgery. When ACL reconstruction is indicated, surgery ≤3 months after injury is associated with a lower risk of intra-articular damage.

Registration:

CRD42016032846 (PROSPERO).

中文翻译：

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前交叉韧带重建时间与软骨损伤的关系：系统评价和荟萃分析

背景：

前交叉韧带 (ACL) 损伤后，ACL 重建的最佳时机以及该时机对软骨损伤的影响仍不清楚。

目的：

通过系统评价和荟萃分析评估 ACL 重建时间对软骨损伤的影响。

学习规划：

系统评价和荟萃分析；证据等级，4。

方法：

两名评价者使用 Cochrane 系统评价方法独立地对 5 个在线数据库进行了系统的文献检索。资格标准是对 16 岁以上患者进行的任何比较研究，这些研究评估了主要 ACL 重建手术的时间与软骨损伤率之间的关系。使用随机效应模型进行荟萃分析。

结果：

筛选后，2363 项研究中有 14 项研究（n = 3559 名患者）符合纳入标准：3 项随机对照试验（n = 272）、3 项前瞻性队列研究（n = 398）和 8 项回顾性队列研究（n = 2889） . 在研究分析中，比较了 3 个时间点前后进行的 ACL 重建之间的软骨损伤率：损伤后 3、6 和 12 个月（例如，≤3 与 >3 个月）。软骨损伤率随着每个时间点的增加而增加。增加主要是由于 3 个月时的轻度损伤（估计比值比，1.914；95% CI，1.242-2.949；P = .003），12 个月后重度损伤的增加成为主要（估计比值比）比率，3.057；95% CI，1.460-6.40；P = .003）。

结论：

我们的研究结果表明，延迟 ACL 重建手术会导致更高的软骨损伤率，并且这些损伤的严重程度会随着时间的推移而恶化。这些发现与我们之前发表的研究结果相当，后者表明与延迟 ACL 手术相关的半月板撕裂风险更高。当需要进行 ACL 重建时，受伤后 ≤ 3 个月的手术与较低的关节内损伤风险相关。

登记：

CRD42016032846（普洛斯彼罗）。