Abstract
PurposeThe purpose of this study was to compare clinical outcomes and incidence of concomitant injuries in patients undergoing early vs delayed surgical treatment of single anterior cruciate ligament (ACL) injury and multiligament knee injury (MLKI).MethodsA literature search using PubMed, Embase, the Cochrane Library, the Cumulative Index to Nursing and Allied Health, and Scopus from their inception to April 30, 2020 was conducted. Studies with levels I to IV evidence reporting the incidence of meniscus or cartilage injury according to early vs delayed surgery in single ACL injuries and MLKIs were included. In the meta-analysis, data based on the number of meniscus and cartilage injuries were extracted and pooled. Lysholm and Tegner scores were analyzed using two-sample Z-tests to calculate the non-weighted mean difference (NMD). A meta-regression analysis was also performed to determine the effect of single ACL injury and MLKI/study design.ResultsSixteen studies on single ACL injury and 14 studies on MLKI were included in this analysis. In the analysis, there were significant decreases in Lysholm score (NMD − 5.3 [95% confidence interval (CI) − 7.37 to − 3.23]) and Tegner score (NMD − 0.25 [95% CI − 0.45 to − 0.05]) and increases in risk of meniscus tear (odds ratio [OR] 1.73 [95% CI 1.1–2.73], p = 0.01) and cartilage injury (OR 2.48 [95% CI 1.46–4.2], p = 0.0007) in the delayed surgery group regardless of single ACL injury or MLKI. The result of the meta-regression analysis indicated that single ACL injury and MLKI/study design were not significant moderators of overall heterogeneity (p > 0.05).ConclusionsOur study suggests that delayed ACL surgery significantly resulted in a higher risk of meniscus tear and cartilage injury and decreased Lysholm and Tegner scores compared to early ACL surgery. The Lysholm scores in the delayed MLKI surgery group were significantly decreased, but the risks of meniscus tear and cartilage injury in the delayed MLKI surgery group remained unclear.Level of evidenceLevel III, meta-analysis.
Highlights
Treatment of multiligament knee injury (MLKI) is still challenging for orthopedic surgeons because of its complexity and severity, and it might be more common than previously reported [1–6]
The result of the meta-regression analysis indicated that single anterior cruciate ligament (ACL) injury and MLKI/prospective and retrospective design were not significant moderators of overall heterogeneity (Fig. 4b, p = 0.255)
In the subgroup analysis according to the type of injury, the Lysholm score of the delayed surgery MLKI group was significantly lower than that of the early surgery MLKI group, and the Lysholm score of the delayed surgery single ACL group was significantly lower than that of the early surgery single ACL group
Summary
Treatment of multiligament knee injury (MLKI) is still challenging for orthopedic surgeons because of its complexity and severity, and it might be more common than previously reported [1–6]. In patients without any emergencies, the timing of surgery is still controversial [4, 8–10]. Even in patients with an anterior cruciate ligament (ACL) injury, the timing of surgery is controversial [13–20]. ACL reconstruction is likely recommended [17, 21–23] because there is an increased risk of meniscus and cartilage injury if it is delayed [21, 22]. In a study of Norwegian National Registry data, the odds of a cartilage lesion increased by nearly 1% for each month from the injury date, and the odds of cartilage lesions were nearly twice as frequent when combined with meniscal tear [24]. There were studies which reported no differences between early and delayed surgery [13, 18, 25, 26]. There is still a lack of consensus regarding the timing of surgery, regardless of the type of injury (single ACL injuries or MLKI) [6, 9, 16–20]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
