J Korean Orthop Assoc JKOA Journal of the Korean Orthopaedic Association 1226-2102 2005-8918 The Korean Orthopaedic Association 10.4055/jkoa.2014.49.4.263 Original Article A Comparison of Clinical Results and Second-Look Arthroscopic Findings between Early and Delayed Reconstruction in Acute Anterior Cruciate Ligament Injuries Lee Soo Won M.D. Kim Sung Hwan M.D. Lee Yong Sik M.D. Ahn Byung Kil M.D. Baek Samuel M.D. Chung Chae Hoon M.D. Department of Orthopedic Surgery, Pohang Sunlin Hospital, Pohang, Korea. Correspondence to: Sung Hwan Kim, M.D. Department of Orthopedic Surgery, Pohang Sunlin Hospital, 43 Daesin-ro, Buk-gu, Pohang 791-704, Korea. TEL: +82-54-245-5163, FAX: +82-54-245-5345, klein95@naver.com 08 2014 27 08 2014 49 4 263 271 18 12 2013 10 02 2014 08 05 2014 Copyright © 2014 by The Korean Orthopaedic Association 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 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.

 anterior cruciate ligament acute injury early reconstruction delayed reconstruction second-look arthroscopy 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 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 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 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 Owings MF Kozak LJ Ambulatory and inpatient procedures in the United States, 1996 Vital Health Stat 13 1998 139 1 119 Shelbourne KD Johnson GE Outpatient surgical management of arthrofibrosis after anterior cruciate ligament surgery Am J Sports Med 1994 22 192 197 Shelbourne KD Patel DV Timing of surgery in anterior cruciate ligament-injured knees Knee Surg Sports Traumatol Arthrosc 1995 3 148 156 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 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 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 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 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 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 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 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 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 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 Mayr HO Weig TG Plitz W Arthrofibrosis following ACL reconstruction--reasons and outcome Arch Orthop Trauma Surg 2004 124 518 522 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 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 Shelbourne KD Patel DV Rehabilitation after autogenous bone-patellar tendon-bone ACL reconstruction Instr Course Lect 1996 45 263 273 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 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 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

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.

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.

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.

Demographic Data

Values are presented as only number or mean±standard deviation (range). Group A: a group underwent early anterior cruciate ligament (ACL) reconstruction, Group B: a group underwent delayed ACL reconstruction.

Clinical Outcome

Values are presented as only number or mean±standard deviation (range). Group A: a group underwent early ACL reconstruction, Group B: a group underwent delayed anterior cruciate ligament (ACL) reconstruction. IKDC, International Knee Documentation Committee.

Range of Motion Deficit

Values are presented as mean±standard deviation or range. Group A: a group underwent early anterior cruciate ligament (ACL) reconstruction, Group B: a group underwent delayed ACL reconstruction.

Lachman Test and Pivot Shift Test

Values are presented as number. Group A: a group underwent early anterior cruciate ligament (ACL) reconstruction, Group B: a group underwent delayed ACL reconstruction.

Comparision of Manual Graft Tension between the Two Groups

Values are presented as number (%). Group A: a group underwent early anterior cruciate ligament (ACL) reconstruction, Group B: a group underwent delayed ACL reconstruction.

Comparision of Synovial Coverage between the Two Groups

Values are presented as number (%). Group A: a group underwent early anterior cruciate ligament (ACL) reconstruction, Group B: a group underwent delayed ACL reconstruction.