Optimal surgical timing for anterior cruciate ligament reconstruction to minimize osteoarthritis incidence: A...

Anterior cruciate ligament (ACL) injury is a common cause of knee instability and may contribute to the development of osteoarthritis (OA). Whether the timing of ACL reconstruction influences the subsequent risk of OA remains uncertain.

To compare the incidence of OA and secondary knee complications following early versus delayed ACL reconstruction.

A systematic search was conducted in PubMed, the Cochrane Library, Embase, Web of Science, and Scopus. The review was reported according to the PRISMA 2020 guidelines. Randomized controlled trials and cohort studies comparing OA incidence after early versus delayed ACL reconstruction were eligible. Methodological quality and risk of bias were assessed using the Newcastle-Ottawa Scale and the RoB 2 tool, as appropriate.

Five studies involving 1,659 patients were included. Definitions of early and delayed ACL reconstruction varied across studies. Follow-up ranged from 5 to 17.5 years, and the reported incidence of OA ranged from 2% to 49%, with heterogeneous assessment methods, including radiographic grading and patient-reported outcome measures. Delayed reconstruction was associated with a higher incidence of secondary meniscal injuries and subsequent meniscectomies. Total knee arthroplasty rates were also higher in delayed reconstruction groups, reaching 10.9%, compared with up to 0.2% in early reconstruction groups.

Early ACL reconstruction may be associated with fewer secondary knee complications, particularly meniscal injuries, meniscectomies, and subsequent knee arthroplasty. However, substantial heterogeneity in the definitions of surgical timing, OA assessment methods, and follow-up duration limits the certainty of these findings. Further studies using standardized definitions and outcome measures are needed to determine the optimal timing of ACL reconstruction for reducing long-term OA risk.