Early Anterior Cruciate Ligament Reconstruction Is Associated With Decreased Risk of Osteoarthritis Compared With Delayed Reconstruction: A Systematic Review and Meta-analysis.

Abstract

Anterior cruciate ligament (ACL) injuries are common, and ACL reconstruction (ACLR) restores stability and enables return to sport. To date, however, studies have failed to show that ACLR prevents long-term osteoarthritis, but the role of timing of ACLR in osteoarthritis has not been extensively examined in meta-analyses. To compare the risk of long-term osteoarthritis after early versus delayed ACLR in the literature. Systematic review and meta-analysis; Level of evidence, 4. The PubMed, Embase, and Cochrane Library databases were searched from 2000 to August 2024 for studies comparing osteoarthritis between early and delayed ACLR at a minimum 5-year follow-up. Outcomes are reported as risk reduction with 95% confidence interval for osteoarthritis incidence, and odds ratio with 95% confidence interval for difference in time from injury to surgery. Random-effects models were used. Seventeen studies (3953 ACLRs) were included (mean age, 28.8 years; 67% male; mean follow-up, 13.3 years; 52% meniscectomy; 31% osteoarthritis incidence). The quality of the studies was rated as moderate, with a Methodological Index for Non-Randomized Studies score of 78% of maximum. Overall, earlier ACLR led to a 10% reduction in osteoarthritis compared with delayed ACLR (95% CI, 6%-14%; <i>P</i> < .001). Two studies (1474 patients) reported a 6% incidence reduction when ACLR was performed within versus after 1 month (95% CI, 2%-10%; <i>P</i> = .005). Similarly, 4 studies (349 patients) reported a 16% incidence reduction when ACLR was performed within versus after 6 months (95% CI, 5%-26%; <i>P</i> = .004), and 5 studies (2248 patients) showed a 13% osteoarthritis reduction with ACLR within versus after 12 months (95% CI, 6%-20%; <i>P</i> = .003). Six studies (685 patients) reported that patients without osteoarthritis were operated on a mean 15 months earlier than patients who developed osteoarthritis (95% CI, 2-29 months; <i>P</i> = .03). This systematic review with a 5-year minimum follow-up demonstrates that shorter time from injury to ACLR was associated with a decreased incidence of long-term osteoarthritis. This reduced risk was already seen when surgery was performed within 1 month but most pronounced within 6 months and 12 months.