前交叉韧带重建时机与相关关节内病变及患者报告结局：系统综述
简介
该系统综述纳入11项观察性研究、逾9500例患者，比较伤后3个月内与3个月后行ACL重建的差异。延迟重建组半月板损伤发生率更高（59.6% vs 49.5%），尤以内侧半月板为著；软骨损伤及KOOS、IKDC、Lysholm等患者报告结局两组无一致差异，而关节松弛度、翻修、重返运动及骨关节炎因证据不足无法评估。提示早期重建可能降低半月板损伤风险，但受观察性设…
英文摘要
IMPORTANCE: The optimal timing of anterior cruciate ligament (ACL) reconstruction (ACLR) remains debated, especially regarding its association with intra-articular pathology and postoperative outcomes. Clarifying these associations is important when counselling patients and deciding between early reconstruction and initial rehabilitation with optional delayed ACLR. AIM: To assess whether ACLR performed within versus after three months from injury was associated with differences in intra-articular pathology, patient-reported outcomes, knee laxity, revision surgery, return to sport (RTS), and osteoarthritis (OA). EVIDENCE REVIEW: PubMed, Excerpta Medica Database (EMBASE), Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Library were searched on July 10, 2025. Clinical studies published in English from 2000 onward comparing early versus delayed ACLR in patients aged 16 years or older were included. Study screening, data extraction, and quality assessment were performed independently by two reviewers, with disagreements resolved by discussions with a third reviewer. The quality of non-randomized studies was assessed using the Newcastle-Ottawa Scale (NOS). Owing to heterogeneity in study design, definitions of surgical timing, outcome measures, and reporting formats, data were synthesized narratively. FINDINGS: The search identified 2,851 records, of which 11 observational studies including more than 9,500 patients met the inclusion criteria. Delayed ACLR was associated with a higher prevalence of meniscal injury compared with early reconstruction (59.6% vs 49.5%), particularly involving the medial meniscus. Chondral lesions were reported at similar frequencies in the delayed and early groups (20.4% vs 18.6%). Patient-reported outcomes (PROs), including Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee subjective knee form (IKDC), Tegner and Lysholm scores, were inconsistently reported and did not show a consistent advantage for either early or delayed reconstruction. No included study reported KT-1000 arthrometer measurements, RTS, or OA outcomes, and revision surgery was sparsely reported. CONCLUSIONS: and Relevance: Early ACLR within three months after injury was associated with a lower prevalence of meniscal injury compared with reconstruction performed after three months. No clear differences were identified for chondral lesions or PROs, while evidence was insufficient to assess knee laxity, revision surgery, RTS, or OA. These findings should be interpreted carefully given the observational design of the included studies and the heterogeneity in outcome reporting. LEVEL OF EVIDENCE: Level 3. CLINICAL TRIAL REGISTRATION: PROSPERO registration number CRD420251104801.