Related Experiment Video
Updated: Sep 13, 2026
Early Weight-Bearing Rehabilitation Protocol After Anterior Cruciate Ligament Reconstruction
Published on: March 1, 2024
Timing of Anterior Cruciate Ligament Reconstruction and Associated Intra-Articular Pathology and Patient-Reported
Kristian Heder Ternell1, Erik Nilsson2, Riccardo Cristiani3
1Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Gothenburg, Sweden.
Importance:
The optimal timing of anterior cruciate ligament (ACL) reconstruction (ACLR) remains debated, especially regarding its association with intra-articular pathology and postoperative outcomes. Clarifying these associations is important when counselling patients and deciding between early reconstruction and initial rehabilitation with optional delayed ACLR.
Aim:
To assess whether ACLR performed within versus after three months from injury was associated with differences in intra-articular pathology, patient-reported outcomes, knee laxity, revision surgery, return to sport (RTS), and osteoarthritis (OA).
Evidence Review:
PubMed, Excerpta Medica Database (EMBASE), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library were searched on July 10, 2025. Clinical studies published in English from 2000 onward comparing early versus delayed ACLR in patients aged 16 years or older were included. Study screening, data extraction, and quality assessment were performed independently by two reviewers, with disagreements resolved by discussions with a third reviewer. The quality of non-randomized studies was assessed using the Newcastle-Ottawa Scale (NOS). Owing to heterogeneity in study design, definitions of surgical timing, outcome measures, and reporting formats, data were synthesized narratively.
Findings:
The search identified 2,851 records, of which 11 observational studies including more than 9,500 patients met the inclusion criteria. Delayed ACLR was associated with a higher prevalence of meniscal injury compared with early reconstruction (59.6% vs 49.5%), particularly involving the medial meniscus. Chondral lesions were reported at similar frequencies in the delayed and early groups (20.4% vs 18.6%). Patient-reported outcomes (PROs), including Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee subjective knee form (IKDC), Tegner and Lysholm scores, were inconsistently reported and did not show a consistent advantage for either early or delayed reconstruction. No included study reported KT-1000 arthrometer measurements, RTS, or OA outcomes, and revision surgery was sparsely reported.
Conclusions:
and Relevance: Early ACLR within three months after injury was associated with a lower prevalence of meniscal injury compared with reconstruction performed after three months. No clear differences were identified for chondral lesions or PROs, while evidence was insufficient to assess knee laxity, revision surgery, RTS, or OA. These findings should be interpreted carefully given the observational design of the included studies and the heterogeneity in outcome reporting.
Level Of Evidence:
Level 3.
Clinical Trial Registration:
PROSPERO registration number CRD420251104801.