Timing of Anterior Cruciate Ligament Repair: Now, Later, or Never?

Anterior cruciate ligament (ACL) tears can lead to joint instability and impaired knee function. Standard treatment is reconstruction, usually using patellar or hamstring tendon autograft; 200,000 such operations are performed annually in the U.S., despite no evidence of benefit beyond that of rehabilitation therapy.

In a Swedish trial of immediate versus delayed reconstruction, 121 athletically active adults (mean age, 26) with total acute ACL tears received standardized structured rehabilitation. Participants were randomized to reconstruction within 10 weeks of injury or to delayed reconstruction, with the option of surgery in the presence of continued serious instability and dysfunction.

At 2 years, roughly a third of patients in the delay…