Postoperative range of motion following anterior cruciate ligament reconstruction using autograft hamstrings - A prospective, randomized clinical trial of early versus delayed reconstructions

Background: There is a common belief that surgical reconstruction of an acutely torn anterior cruciate ligament (ACL) should be delayed for at least 3 weeks because of the increased incidence of postoperative motion loss (arthrofibrosis) and suboptimal clinical results. Hypothesis: There is no difference in postoperative range of motion or stability after ACL reconstructions performed either acutely or delayed. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients with an acute ACL tear were prospectively randomized to either early ( within 21days) or delayed ( beyond 6 weeks) reconstruction using autograft hamstring tendon. Previous knee surgery on the index extremity and a multiligamentous injury were exclusionary criteria. Surgical technique and postoperative rehabilitation were identical for all patients. Postoperative assessments included range of motion and KT-1000 arthrometer measurements compared with the contralateral knee. Standardized outcome measures were used including single assessment numeric evaluation (SANE), Lysholm, and Tegner Activity Score. Results: Seventy consecutive patients were enrolled, and 1 patient was dropped after a postoperative infection. Sixty-nine patients ( 34 acute, 35 delayed) with an average age of 27 years composed the study cohort. The mean time from injury to surgery was 9 days ( range, 2-17 days) for patients in the early group and 85 days (range, 42-192) for those in the delayed group. The average follow-up from surgery was 366 days ( range, 185-869). Articular cartilage and meniscal injuries were comparable between the 2 groups. There were no significant differences between the 2 treatment groups in degrees of extension or flexion lost relative to the nonoperative side, operative time, KT-1000 arthrometer differences, or subjective knee evaluations. Conclusion: Excellent clinical results can be achieved after ACL reconstructions performed soon after injury using autograft hamstrings. Although the authors do not advocate that all reconstructions should be performed acutely, they found that early ACL reconstructions do not result in loss of motion or suboptimal clinical results as long as a rehabilitation protocol emphasizing extension and early range of motion is employed.