Does earlier anterior cruciate ligament reconstruction reduce the risk of meniscal and articular cartilage injury in children and adolescents? A systematic review.

Abstract

The optimal timing for surgery following anterior cruciate ligament (ACL) rupture in adolescents has been a subject of considerable debate. To evaluate the effect of early or delayed ACL reconstruction on the risk of secondary meniscus and articular cartilage injury in adolescents with ruptured ACL. Medline, PubMed, EMBase, and Cochrane Library were searched for studies on the timing of surgery for ACL reconstruction in children or adolescents from January 2000 to April 2023, and quantitative analysis was performed. A total of 12 studies representing 2355 patients met our criteria. The analysis indicated that patients who underwent early ACLR had a lower risk of secondary inner meniscal (risk ratio (RR) = 0.41, 95 % confidence interval (CI) (0.30, 0.56), P < 0.00001) and outer meniscal (RR = 0.71, 95 % CI (0.46, 1.08), P = 0.11) injuries compared with those with delayed reconstruction. There was also a significantly reduced risk of secondary inner femoral condyle cartilage (RR = 0.53, 95 % CI (0.43, 0.66), P < 0.00001), outer femoral condyle cartilage (RR = 0.60, 95 % CI (0.38, 0.97), P = 0.04), patellar cartilage (RR = 0.39, 95 % CI (0.19, 0.80), P = 0.01) injuries in the early reconstruction group in comparison with the delayed group. For children and adolescents with ACL rupture, early ACL reconstruction can reduce the incidence of secondary medial and lateral meniscus, femoral condylar cartilage and patellofemoral articular cartilage injuries.