Timing of surgery of the anterior cruciate ligament

Arthroscopy. 2013 Nov;29(11):1863-71. doi: 10.1016/j.arthro.2013.07.270. Epub 2013 Sep 18.


Purpose: We aimed to perform a systematic review of the literature concerned with timing of surgery after anterior cruciate ligament injury.

Methods: A systematic electronic search in Medline through PubMed, Embase, and the Cochrane Library was carried out in October 2011. All English-language randomized controlled clinical trials, prospective comparative cohort studies, and prognostic and diagnostic studies published from January 1995 to August 2011 were eligible for inclusion. All articles addressing timing of surgery were eligible for inclusion regardless of injury-to-surgery interval, graft type, surgical technique, or rehabilitation. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guided the reporting and data abstraction. Methodologic quality of all included articles was carefully assessed.

Results: We included 22 articles (3,583 patients) in the systematic review. Study design, research methodology, surgical technique, and outcome measurements differed greatly among included articles. The injury-to-surgery interval, classified as early and delayed, ranged from within 2 days to 7 months and 3 weeks to 24 years, respectively. Eight articles promoted early reconstruction, whereas the majority of articles found no difference in outcome between early and delayed surgery. Two articles were inconclusive.

Conclusions: There were few or no differences in subjective and objective outcomes related to timing of anterior cruciate ligament reconstruction.

Level of evidence: Level II, systematic review of Level I and II studies.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Anterior Cruciate Ligament / surgery*
  • Anterior Cruciate Ligament Injuries*
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Evidence-Based Medicine
  • Humans
  • Knee Injuries / rehabilitation
  • Knee Injuries / surgery
  • Prospective Studies
  • Reconstructive Surgical Procedures / methods*
  • Secondary Prevention
  • Time Factors