Early anterior cruciate ligament reconstruction within 14 days is safe and effective: Favourable clinical outcomes in 203 consecutive patients with a minimum 2‐year follow‐up

Abstract Purpose The purpose of this study was to evaluate the clinical outcomes of acute anterior cruciate ligament reconstruction (ACLR) performed within 14 days of injury with a minimum follow‐up of 2 years. The hypothesis was that early ACLR would result in favourable clinical outcomes without a significant increase in complications. The secondary aim was to identify predictors of graft failure and complications, with the hypothesis that younger age and higher activity level would be associated with increased risk. Methods A retrospective analysis was performed on patients who underwent ACLR within 14 days at a single institution. Potential risk factors for graft rupture and other post‐operative complications were analyzed. Knee stability was assessed using KT‐1000 and pivot shift test, and range of motion (ROM) with a goniometer. Patient‐reported outcome measures (PROMs), including IKDC (International Knee Documentation Committee), Lysholm, Tegner activity scale and KOOS (Knee injury and Osteoarthritis Outcome Score), were evaluated. Results The final population consisted of 203 patients. At a mean follow‐up of 53.4 months (range: 24–85), the graft rupture rate was 1.9%. Age 20 years or younger was the only significant risk factor for graft rupture (odds ratio = 6.02, p = 0.013). Post‐operative negative pivot shift was achieved in 93.6%. The mean post‐operative KOOS was 91.7 ± 8.8, the mean IKDC score was 88.1 ± 13.4, and the mean Lysholm score was 93.2 ± 9.9. In addition, 75% of patients returned to their pre‐injury level of sports activity or higher. The mean loss of side‐to‐side extension was 1.3°, and flexion was 4.6°. The overall complication rate was 10.2%, with an incidence of post‐operative stiffness requiring re‐intervention of 1.5% and a 3.4% incidence of septic arthritis. Conclusion Early ACLR resulted in favourable clinical outcomes, including high rates of return to sport, minimal ROM deficits, and high PROM scores, with a low graft failure rate (1.9%), despite a 3.4% incidence of septic arthritis. Level of Evidence Level IV.