Timing of anterior cruciate ligament reconstruction to prevent meniscal tears: a systematic review and meta-analysis (Free Paper Session V, Sports Medicine).

Abstract

<p><strong>Introduction: </strong>Considerable variability exists for the definitions of both early and delayed primary anterior cruciate ligament reconstruction (ACLR), with no consensus on when to perform ACLR to minimise meniscal tears. This systematic review aims to identify the optimal timepoint that is associated with a significant increase in meniscal tears found at the time of ACLR.</p><p><strong>Methods: </strong>Two independent researchers searched Embase, Cochrane Library, MEDLINE, PubMed, and Web of Science for clinical studies reporting the rates of meniscal tears found at the time of primary ACLR. Studies on revision ACLR and multi-ligamentous injury were excluded. Meta-regression was performed to identify the optimal timepoint, and meta-analysis was performed to compare the rates of meniscal tears with respect to the timepoint. Risk of bias was assessed using ROBINS-I.</p><p><strong>Results: </strong>Forty studies with 104 425 knees were included. Twenty-two studies including 16 768 knees showed that ACLR performed >12 months was the best predictor of medial and lateral meniscal tears (p<0.001). After 12 months, the rates of medial meniscal tears increased significantly (odds ratio=3.09, 95% confidence interval=2.36-4.05, I2=91%). Overall risk of bias was low.</p><p><strong>Conclusion:</strong> To prevent meniscal tears, ACLR should be performed <12 months after injury. A limitation of this systematic review was the high heterogeneity of patient characteristics and outcomes. Future studies should assess meniscal tear patterns that contribute to the increase in meniscal tears over time.</p>