Acute Anterior Cruciate Ligament Reconstruction Performed Within 10 Days of Injury Does Not Increase Risk of Postoperative Arthrofibrosis: A Systematic Review and Meta-analysis.

Autor:	Aman ZS; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Blaber OK; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA., R McDermott E; Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA., DeFoor MT; Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA., DePhillipo NN; Department of Orthopedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA., Dickens JF; Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA., Dekker TJ; Department of Orthopaedic Surgery, 10th Medical Group, US Air Force Academy, Colorado Springs, Colorado, USA.
Jazyk:	angličtina
Zdroj:	The American journal of sports medicine [Am J Sports Med] 2024 Jun; Vol. 52 (7), pp. 1888-1896. Date of Electronic Publication: 2024 Jan 23.
DOI:	10.1177/03635465231192987
Abstrakt:	Background: The optimal timing of anterior cruciate ligament (ACL) reconstruction (ACLR) remains a controversial topic. Previous reviews have demonstrated that there are no differences between early and delayed ACLR; however, these studies have been limited by heterogeneous definitions of acute ACL injury. Purpose: To evaluate postoperative patient functional outcomes and risk for arthrofibrosis after acute arthroscopic ACLR performed ≤10 days after injury. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using multiple medical databases. Inclusion criteria were studies that evaluated postoperative range of motion outcomes for patients undergoing ACLR ≤10 days after initial ACL injury. For included comparative studies comparing patient groups undergoing ACLR ≤10 days and patients undergoing "delayed" ACLR after ≥3 weeks of initial injury, quantitative analysis was performed to assess for differences in postoperative arthrofibrosis, reoperation rates, and patient-reported outcomes between groups. DerSimonian-Laird binary random-effects models were constructed to quantitatively describe the association between the ACLR time period and patient outcomes by generating effect estimates in the form of odds ratios with 95% CIs. Qualitative analysis was performed to describe variably reported patient outcomes and the risk of arthrofibrosis after ACLR for noncomparative studies. Results: Screening yielded 6 full-text articles with 448 patients who underwent ACLR (296 ACLR <10 days, 152 ACLR >3 weeks), with a pooled mean age of 28.1 years. For studies amenable to quantitative analysis, there were no significant differences between ACLR performed ≤10 days and ACLR performed at the 3-week point or after in terms of postoperative stiffness (3 studies; odds ratio, 1.27; P = .508), Tegner scores (2 studies; mean difference, -0.056; P = .155), or reoperation for stiffness (3 studies; odds ratio, 0.869; P = .462). The overall incidence of postoperative arthrofibrosis after 12 months of follow-up was 11 of 296 (3.7%) for ACLRs performed ≤10 days versus 6 of 152 (3.9%) for those performed at the 3-week point or after. Conclusion: ACLR performed ≤10 days after the inciting injury does not increase the risk of postoperative arthrofibrosis and demonstrates similar patient-reported outcomes compared with ACLR performed at the 3-week point or after. Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: E.M. has received support for education from Medinc Texas and has a family member employed by Medinc of Texas (Arthrex Inc). J.F.D. has received support for education from Supreme Orthopedic Systems and speaking fees from Arthrex. T.J.D. has received hospitality payments from Zimmer BioMet Holdings, Inc; travel expenses from Arthrex; support for education from Smith & Nephew and CGG Medical; and a grant from DJO. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Databáze:	MEDLINE
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