Timing of Surgery for ACL Tears: Early or Late?Many surgeons wait three weeks before doing surgery to repair a torn anterior cruciate ligament (ACL). The belief is that loss of motion and poorer results occur after early surgery. And anyone with limited motion or bleeding into the knee joint should wait to have surgery. Is this wait really necessary?
In this study, active duty military men and women with an acute ACL tear were divided into two surgical groups: early (within three weeks) and late (after six weeks). Half of the early group did have the surgery within one week's time of the injury. Everyone had the same surgical procedure done: an ACL reconstruction using their own hamstring tendon grafts. The rehab program was identical for each patient, too.
Patients in the delayed surgery group were not allowed to participate in sports or military duty during the waiting period. Everyone was tested before and after the surgery. Measurements taken included range of motion, strength, and activity scores.
Patients were evaluated every six months for up to three years. The results showed no difference between the two groups. Loss of knee extension can be a problem for some patients after ACL repair. Only one patient in either of these two groups had this problem. It was not considered significant or linked to the timing of the operation.
The authors suggest that doing the reconstructive procedure early subjects the knee to only one trauma instead of two. They also found that patients felt better when treatment was delivered faster.
In a military setting where every day counts, delaying surgery while continuing to train and drill with the unit can result in more damage to the joint. When surgery must be delayed for any reason, patients should be protected from high-level performance activities to avoid such damage.
It appears that ACL reconstructive surgery doesn't have to be delayed to protect the knee and obtain a better result. In fact, it may be more the case that early surgery for an acute ACL injury will result in better outcomes. This study was done on active duty servicemen and servicewomen. Similar results may not occur with patients who are not military or athletic.
Craig R. Bottoni, MD, et al. Postoperative Range of Motion Following Anterior Cruciate Ligament Reconstruction Using Autograft Hamstrings. In The American Journal of Sports Medicine. April 2008. Vol. 36. No. 4. Pp. 656-662.
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