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Anterior Cruciate Ligament Reconstruction Within 3 Weeks Does Not Increase Stiffness and Complications Compared With Delayed Reconstruction: A Meta-analysis of Randomized Controlled Trials.

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  • معلومة اضافية
    • Author-Supplied Keywords:
      ACL reconstruction
      ACL tear
      delayed reconstruction
      early reconstruction
      knee
    • Abstract:
      Background: Injury-to-surgery time has been identified as a key point in anterior cruciate ligament (ACL) reconstruction, with early versus delayed treatment remaining a debated and controversial topic in the management of ACL tears. Purpose/Hypothesis: The aim was to quantitatively synthesize the best literature evidence by including only randomized controlled trials (RCTs) comparing early versus delayed ACL reconstruction, with a clear and univocal definition of cutoffs of early or delayed surgery. The hypothesis was that early treatment would lead to similar final clinical results compared with the delayed approach while providing a faster recovery without an increase in complications after ACL reconstruction. Study Design: Meta-analysis. Methods: A systematic literature search was performed on February 12, 2019, using PubMed, Web of Science, Cochrane Library, and gray literature databases. According to previous literature, 2 analyses with different cutoffs for injury-to-surgery time (3 weeks and 10 weeks) were performed to distinguish early and delayed reconstruction. The influence of timing was analyzed through meta-analyses in terms of patient-reported outcome measures (PROMs), risk of complications, range of motion (ROM) limitation, risk of retears, and residual laxity. Risk of bias and quality of evidence were assessed following the Cochrane guidelines. Results: Eight studies (5 in 3-week cutoff analysis and 3 in 10-week cutoff analysis) were included. No differences were found in terms of PROMs, risk of complications, ROM limitation, risk of retears, and residual laxity either in the 3-week cutoff analysis or in the 10-week cutoff analysis (P >.05). The level of evidence was moderate to low for the outcomes of the 3-week cutoff analysis and low to very low for the outcomes of the 10-week cutoff analysis. Conclusion: This meta-analysis did not confirm the previously advocated benefits of delaying ACL surgery to avoid the acute posttraumatic phase. In fact, RCTs demonstrated that timing of surgery after ACL tears has no influence on the final functional outcome, risk of retears, or residual instability. While no data were available about the recovery time, literature results showed that early ACL reconstruction could be performed without increasing the risk of complications. Study Registration: CRD42019119319 (PROSPERO). [ABSTRACT FROM AUTHOR]
    • Abstract:
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    • Author Affiliations:
      1Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
      2Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
      3Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
    • Full Text Word Count:
      6218
    • ISSN:
      0363-5465
    • Accession Number:
      10.1177/0363546519862294
    • Accession Number:
      142579446
  • Citations
    • ABNT:
      DEABATE, L. et al. Anterior Cruciate Ligament Reconstruction Within 3 Weeks Does Not Increase Stiffness and Complications Compared With Delayed Reconstruction: A Meta-analysis of Randomized Controlled Trials. American Journal of Sports Medicine, [s. l.], v. 48, n. 5, p. 1263–1272, 2020. DOI 10.1177/0363546519862294. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=asn&AN=142579446&custid=s8280428. Acesso em: 15 jul. 2020.
    • AMA:
      Deabate L, Previtali D, Grassi A, Filardo G, Candrian C, Delcogliano M. Anterior Cruciate Ligament Reconstruction Within 3 Weeks Does Not Increase Stiffness and Complications Compared With Delayed Reconstruction: A Meta-analysis of Randomized Controlled Trials. American Journal of Sports Medicine. 2020;48(5):1263-1272. doi:10.1177/0363546519862294.
    • AMA11:
      Deabate L, Previtali D, Grassi A, Filardo G, Candrian C, Delcogliano M. Anterior Cruciate Ligament Reconstruction Within 3 Weeks Does Not Increase Stiffness and Complications Compared With Delayed Reconstruction: A Meta-analysis of Randomized Controlled Trials. American Journal of Sports Medicine. 2020;48(5):1263-1272. doi:10.1177/0363546519862294
    • APA:
      Deabate, L., Previtali, D., Grassi, A., Filardo, G., Candrian, C., & Delcogliano, M. (2020). Anterior Cruciate Ligament Reconstruction Within 3 Weeks Does Not Increase Stiffness and Complications Compared With Delayed Reconstruction: A Meta-analysis of Randomized Controlled Trials. American Journal of Sports Medicine, 48(5), 1263–1272. https://doi.org/10.1177/0363546519862294
    • Chicago/Turabian: Author-Date:
      Deabate, Luca, Davide Previtali, Alberto Grassi, Giuseppe Filardo, Christian Candrian, and Marco Delcogliano. 2020. “Anterior Cruciate Ligament Reconstruction Within 3 Weeks Does Not Increase Stiffness and Complications Compared With Delayed Reconstruction: A Meta-Analysis of Randomized Controlled Trials.” American Journal of Sports Medicine 48 (5): 1263–72. doi:10.1177/0363546519862294.
    • Harvard:
      Deabate, L. et al. (2020) ‘Anterior Cruciate Ligament Reconstruction Within 3 Weeks Does Not Increase Stiffness and Complications Compared With Delayed Reconstruction: A Meta-analysis of Randomized Controlled Trials’, American Journal of Sports Medicine, 48(5), pp. 1263–1272. doi: 10.1177/0363546519862294.
    • Harvard: Australian:
      Deabate, L, Previtali, D, Grassi, A, Filardo, G, Candrian, C & Delcogliano, M 2020, ‘Anterior Cruciate Ligament Reconstruction Within 3 Weeks Does Not Increase Stiffness and Complications Compared With Delayed Reconstruction: A Meta-analysis of Randomized Controlled Trials’, American Journal of Sports Medicine, vol. 48, no. 5, pp. 1263–1272, viewed 15 July 2020, .
    • MLA:
      Deabate, Luca, et al. “Anterior Cruciate Ligament Reconstruction Within 3 Weeks Does Not Increase Stiffness and Complications Compared With Delayed Reconstruction: A Meta-Analysis of Randomized Controlled Trials.” American Journal of Sports Medicine, vol. 48, no. 5, Apr. 2020, pp. 1263–1272. EBSCOhost, doi:10.1177/0363546519862294.
    • Chicago/Turabian: Humanities:
      Deabate, Luca, Davide Previtali, Alberto Grassi, Giuseppe Filardo, Christian Candrian, and Marco Delcogliano. “Anterior Cruciate Ligament Reconstruction Within 3 Weeks Does Not Increase Stiffness and Complications Compared With Delayed Reconstruction: A Meta-Analysis of Randomized Controlled Trials.” American Journal of Sports Medicine 48, no. 5 (April 2020): 1263–72. doi:10.1177/0363546519862294.
    • Vancouver/ICMJE:
      Deabate L, Previtali D, Grassi A, Filardo G, Candrian C, Delcogliano M. Anterior Cruciate Ligament Reconstruction Within 3 Weeks Does Not Increase Stiffness and Complications Compared With Delayed Reconstruction: A Meta-analysis of Randomized Controlled Trials. American Journal of Sports Medicine [Internet]. 2020 Apr [cited 2020 Jul 15];48(5):1263–72. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=asn&AN=142579446&custid=s8280428