Early Anterior Cruciate Ligament Reconstruction Reduces Long-Term Rates of Secondary Meniscus Surgery: A Systematic Review.

PURPOSE: To evaluate the impact of anterior cruciate ligament reconstruction timing on meniscus injuries, with the rate of secondary meniscus surgery as the primary outcome.

METHODS

We define reconstruction performed more than 6 weeks after injury as delayed reconstruction. Literature was obtained from PubMed/MEDLINE, Embase, the Cochrane Library, and the Web of Science. Outcomes compared included secondary meniscus surgery incidence, secondary meniscus injury rates, differences between medial and lateral meniscus injuries, knee function scores, and knee stability.

RESULTS

After expert consultation and quality assessment, 6 studies involving 933 patients with anterior cruciate ligament rupture were included. Studies with a follow-up duration greater than 5 years concluded that early anterior cruciate ligament reconstruction (ACLR) reduced the risk of secondary meniscus surgery. In contrast, studies with a follow-up duration of less than or equal to 5 years found no statistically significant difference between the early ACLR group and the delayed ACLR group in terms of secondary meniscus surgery outcomes (P = .02). Subgroup analysis showed that in long-term follow-up (>5 years), the rate of secondary meniscus surgery was significantly lower in the early ACLR group compared with the delayed group, and longer follow-up duration was associated with an increasing trend in the rate of secondary meniscus surgery.

CONCLUSIONS

Compared with delayed ACLR, early ACLR reduces long-term (>5 years) rates of secondary meniscus surgery. As time progresses, the difference in the proportion of secondary meniscus surgeries between the 2 groups becomes more pronounced, further highlighting the advantage of early ACLR.

LEVEL OF EVIDENCE: Level II, systematic review of Level I and II studies.