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Early ACL reconstruction is required to prevent additional knee injury: a misconception not supported by high-quality evidence
  1. Stephanie Rose Filbay
  1. Correspondence to Dr Stephanie Rose Filbay, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX37LD, UK; stephanie.filbay{at}

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It is evident that meniscus injury is associated with increased rates of osteoarthritis and joint replacement surgery, and that preserving the meniscus should be a key priority when managing ACL-injured individuals. A common belief within the orthopaedic community is that early ACL reconstruction is necessary to prevent additional meniscus and cartilage injury.1 The studies referenced to support this argument (table 1) are limited by selection and indication bias. While these studies highlight the importance of managing ACL injury early to preserve joint health, they do not provide evidence that early reconstruction is superior to ‘evidence-based rehabilitation’2 in reducing subsequent meniscus or cartilage injury rates. Referenced studies share a similar conclusion that people who present for early reconstruction shortly after ACL injury have less meniscus or cartilage damage than those who present for ACL reconstruction months or years after injury (table 1). This is not surprising; individuals who are chronically ACL deficient may have been incorrectly diagnosed or exposed themselves to sport or other high-risk activities for months or years, without undertaking appropriate rehabilitation. Importantly, studies that found more meniscus or cartilage damage in patients presenting for a delayed reconstruction (following unknown treatment/no treatment) compared with patients presenting for an early reconstruction should not be used to justify recommending early ACL reconstruction over management of an acute ACL injury with evidence-based rehabilitation.

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Table 1

Studies commonly referenced to support the belief …

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  • Contributors SRF is the sole author of this editorial.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.