J Korean Orthop Assoc.  2014 Aug;49(4):263-271. 10.4055/jkoa.2014.49.4.263.

A Comparison of Clinical Results and Second-Look Arthroscopic Findings between Early and Delayed Reconstruction in Acute Anterior Cruciate Ligament Injuries

• Lee SW
• Kim SH
• Lee YS
• Ahn BK
• Baek S
• Chung CH

• KMID: 2185181
• DOI: http://doi.org/10.4055/jkoa.2014.49.4.263

Abstract

PURPOSE
This study was conducted for comparison of clinical and second look arthroscopic results between early and delayed reconstruction of acute anterior cruciate ligament (ACL) injuries.
MATERIALS AND METHODS
Thirty-six patients who underwent ACL reconstruction between March 2008 and October 2011 were enrolled in this study. We divided the patients into two groups, those in the early reconstruction group underwent surgery before one week, and those in the delayed reconstruction group underwent surgery after three weeks, before six weeks. We checked clinical results and second look arthroscopic results and analyzed correlation of clinical and second look arthroscopic results.
RESULTS
At the final follow up, the Lysholm, International Knee Documentation Committee, and Tegner score were not statistically different between the two groups (p=0.173, p=0.154, p=0.109). No difference for the range of motion (p=0.808, p=0.680), Lachman test (p=0.377), and pivot shift test (p=0.894) was observed between the groups. In the results of second look arthroscopy, there was no difference in graft continuity (p=0.936), tension (p=0.944) and synovial coverage (p=0.789). No statistical clinical correlation was observed between clinical and second look arthroscopic results (p>0.05).
CONCLUSION
We obtained satisfactory clinical and second look arthroscopic results in both the early and delayed ACL reconstruction groups. Therefore, early reconstruction of ACL performed before one week could be a treatment options for acute ACL injury.

Keyword

anterior cruciate ligament; acute injury; early reconstruction; delayed reconstruction; second-look arthroscopy

MeSH Terms

Anterior Cruciate Ligament*
Arthroscopy
Follow-Up Studies
Humans
Knee
Range of Motion, Articular
Transplants

Figure

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  Figure 1 Two types of reconstructed anterior cruciate ligament partial tear seen at the graft. (A) Right knee, supine position, anterolateral viewing portal. (B) Left knee, supine position, anterolateral viewing portal.

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  Figure 2 Manual proving of the tension on the reconstructed anterior cruciate ligament. The graft shows nearly normal tension (A) and the graft shows slight laxity (B). (A) Right knee, supine position, anterolateral viewing portal. (B) Left knee, supine position, anterolateral viewing portal.

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  Figure 3 Comparison of synovial coverage to the reconstructed anterior cruciate ligament graft: relatively good (A) and poor synovial coverage is seen on the graft (B). (A) Right knee, supine position, anterolateral viewing portal. (B) Right knee, supine position, anterolateral viewing portal.

Reference

1. Linn RM, Fischer DA, Smith JP, Burstein DB, Quick DC. Achilles tendon allograft reconstruction of the anterior cruciate ligament-deficient knee. Am J Sports Med. 1993; 21:825–831.

2. Levy IM, Torzilli PA, Warren RF. The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am. 1982; 64:883–888.

3. Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am. 1980; 62:259–270.

4. Jomha NM, Pinczewski LA, Clingeleffer A, Otto DD. Arthroscopic reconstruction of the anterior cruciate ligament with patellar-tendon autograft and interference screw fixation. The results at seven years. J Bone Joint Surg Br. 1999; 81:775–779.

5. Owings MF, Kozak LJ. Ambulatory and inpatient procedures in the United States, 1996. Vital Health Stat 13. 1998; (139):1–119.

6. Shelbourne KD, Johnson GE. Outpatient surgical management of arthrofibrosis after anterior cruciate ligament surgery. Am J Sports Med. 1994; 22:192–197.

7. Shelbourne KD, Patel DV. Timing of surgery in anterior cruciate ligament-injured knees. Knee Surg Sports Traumatol Arthrosc. 1995; 3:148–156.

8. Smith TO, Davies L, Hing CB. Early versus delayed surgery for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2010; 18:304–311.

9. Lee SW, Kim SH, Kim YG. A comparison of outcomes after early and delayed reconstruction in the acute anterior cruciate ligament injuries. J Korean Arthrosc Soc. 2012; 16:34–39.

10. Buss DD, Min R, Skyhar M, Galinat B, Warren RF, Wickiewicz TL. Nonoperative treatment of acute anterior cruciate ligament injuries in a selected group of patients. Am J Sports Med. 1995; 23:160–165.

11. Keene GC, Bickerstaff D, Rae PJ, Paterson RS. The natural history of meniscal tears in anterior cruciate ligament insufficiency. Am J Sports Med. 1993; 21:672–679.

12. Bottoni CR, Liddell TR, Trainor TJ, Freccero DM, Lindell KK. Postoperative range of motion following anterior cruciate ligament reconstruction using autograft hamstrings: a prospective, randomized clinical trial of early versus delayed reconstructions. Am J Sports Med. 2008; 36:656–662.

13. Marcacci M, Zaffagnini S, Iacono F, Neri MP, Petitto A. Early versus late reconstruction for anterior cruciate ligament rupture. Results after five years of followup. Am J Sports Med. 1995; 23:690–693.

14. Meighan AA, Keating JF, Will E. Outcome after reconstruction of the anterior cruciate ligament in athletic patients. A comparison of early versus delayed surgery. J Bone Joint Surg Br. 2003; 85:521–524.

15. Petersen W, Laprell H. Combined injuries of the medial collateral ligament and the anterior cruciate ligament. Early ACL reconstruction versus late ACL reconstruction. Arch Orthop Trauma Surg. 1999; 119:258–262.

16. Sgaglione NA, Del Pizzo W, Fox JM, Friedman MJ. Arthroscopically assisted anterior cruciate ligament reconstruction with the pes anserine tendons. Comparison of results in acute and chronic ligament deficiency. Am J Sports Med. 1993; 21:249–256.

17. Wasilewski SA, Covall DJ, Cohen S. Effect of surgical timing on recovery and associated injuries after anterior cruciate ligament reconstruction. Am J Sports Med. 1993; 21:338–342.

18. Mayr HO, Weig TG, Plitz W. Arthrofibrosis following ACL reconstruction--reasons and outcome. Arch Orthop Trauma Surg. 2004; 124:518–522.

19. Millett PJ, Wickiewicz TL, Warren RF. Motion loss after ligament injuries to the knee. Part I: causes. Am J Sports Med. 2001; 29:664–675.

20. Cosgarea AJ, Sebastianelli WJ, DeHaven KE. Prevention of arthrofibrosis after anterior cruciate ligament reconstruction using the central third patellar tendon autograft. Am J Sports Med. 1995; 23:87–92.

21. Shelbourne KD, Patel DV. Rehabilitation after autogenous bone-patellar tendon-bone ACL reconstruction. Instr Course Lect. 1996; 45:263–273.

22. Ahn JH, Yoo JC, Yang HS, Kim JH, Wang JH. Second-look arthroscopic findings of 208 patients after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2007; 15:242–248.

23. Kondo E, Yasuda K. Second-look arthroscopic evaluations of anatomic double-bundle anterior cruciate ligament reconstruction: relation with postoperative knee stability. Arthroscopy. 2007; 23:1198–1209.

24. Scheffler SU, Schmidt T, Gangéy I, Dustmann M, Unterhauser F, Weiler A. Fresh-frozen free-tendon allografts versus autografts in anterior cruciate ligament reconstruction: delayed remodeling and inferior mechanical function during long-term healing in sheep. Arthroscopy. 2008; 24:448–458.