Background:

Injury-to-surgery time has been identified as a key point in anterior cruciate ligament (ACL) reconstruction, with early versus delayed treatment remaining a debated and controversial topic in the management of ACL tears.

Purpose/Hypothesis:

The aim was to quantitatively synthesize the best literature evidence by including only randomized controlled trials (RCTs) comparing early versus delayed ACL reconstruction, with a clear and univocal definition of cutoffs of early or delayed surgery. The hypothesis was that early treatment would lead to similar final clinical results compared with the delayed approach while providing a faster recovery without an increase in complications after ACL reconstruction.

Study Design:

Meta-analysis.

Methods:

A systematic literature search was performed on February 12, 2019, using PubMed, Web of Science, Cochrane Library, and gray literature databases. According to previous literature, 2 analyses with different cutoffs for injury-to-surgery time (3 weeks and 10 weeks) were performed to distinguish early and delayed reconstruction. The influence of timing was analyzed through meta-analyses in terms of patient-reported outcome measures (PROMs), risk of complications, range of motion (ROM) limitation, risk of retears, and residual laxity. Risk of bias and quality of evidence were assessed following the Cochrane guidelines.

Results:

Eight studies (5 in 3-week cutoff analysis and 3 in 10-week cutoff analysis) were included. No differences were found in terms of PROMs, risk of complications, ROM limitation, risk of retears, and residual laxity either in the 3-week cutoff analysis or in the 10-week cutoff analysis (P > .05). The level of evidence was moderate to low for the outcomes of the 3-week cutoff analysis and low to very low for the outcomes of the 10-week cutoff analysis.

Conclusion:

This meta-analysis did not confirm the previously advocated benefits of delaying ACL surgery to avoid the acute posttraumatic phase. In fact, RCTs demonstrated that timing of surgery after ACL tears has no influence on the final functional outcome, risk of retears, or residual instability. While no data were available about the recovery time, literature results showed that early ACL reconstruction could be performed without increasing the risk of complications.

Study Registration:

CRD42019119319 (PROSPERO).

中文翻译：

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与延迟重建相比，三周内前交叉韧带重建与延迟重建相比不会增加刚度和并发症：对随机对照试验的荟萃分析。

背景：

手术时间已被确定为前交叉韧带（ACL）重建的关键点，早期治疗与延迟治疗仍然是ACL眼泪管理中一个有争议和有争议的话题。

目的/假设：

目的是通过仅包括比较早期和延迟ACL重建的随机对照试验（RCT），定量地综合最好的文献证据，并明确，明确地定义早期或延迟手术的临界值。假说是，与延迟治疗相比，早期治疗将导致相似的最终临床结果，同时在ACL重建后提供更快的恢复而不会增加并发症。

学习规划：

荟萃分析。

方法：

使用PubMed，Web of Science，Cochrane图书馆和灰色文献数据库，于2019年2月12日进行了系统的文献检索。根据先前的文献，进行了2个不同的截断手术时间（3周和10周）分析，以区分早期重建和延迟重建。通过荟萃分析对时机的影响进行了分析，包括患者报告的结局指标（PROM），并发症的风险，运动范围（ROM）的限制，后遗的风险和残留的松弛。根据Cochrane指南评估偏倚风险和证据质量。

结果：

包括八项研究（3周临界值分析中的5项和10周临界值分析中的3项）。在3周的截止分析或10周的截止分析中，在PROM，并发症风险，ROM受限，后遗症风险和残留松弛等方面均未发现差异（P > .05）。3周截止分析结果的证据水平为中到低，而10周截止分析结果的证据水平则从低到非常低。

结论：

这项荟萃分析并未证实先前提倡的延迟ACL手术以避免急性创伤后阶段的益处。实际上，RCT证明，ACL撕裂后的手术时机对最终功能结局，后遗风险或残留的不稳定性没有影响。虽然没有关于恢复时间的数据，但文献结果表明，可以在不增加并发症风险的情况下进行早期ACL重建。

研究注册：

CRD42019119319（PROSPERO）。