Early vs. delayed ACL reconstruction: Comparative insight into functional recovery and complication profiles

The anterior cruciate ligament (ACL) is crucial for knee stability, and its injury often necessitates surgical reconstruction. However, the optimal timing of surgery remains controversial. The present study aimed to assess the effects of surgical timing on recovery and patient outcomes. The present retrospective cohort study performed at a tertiary orthopedic center, analyzed 378 patients with ACL injuries (aged 16‑40 years) to compare the outcomes of early (≤12 weeks) vs. delayed (>12 weeks) reconstruction. Data were collected from patient records and validated questionnaires assessing function, complications and satisfaction. Statistical analyses adjusted for confounders. Ethical approval was obtained, and STROBE guidelines were followed throughout the study. As demonstrated by the results, as regards the sample of 378 patients, 108 (28.6%) patients underwent early ACL reconstruction and 270 (71.4%) delayed ACL reconstruction. Males were predominant (94.2%), with a median age of 29 years. Sports injuries caused 74.9% of ACL tears. Pre‑operative rehabilitation was more common in delayed cases (33.3 vs. 22.2%, P=0.035). Excellent Lysholm scores were achieved by 88 (81.5%) patients who underwent early ACL reconstruction vs. 112 (41.5%) patients who underwent delayed ACL reconstruction (P<0.001). Knee stiffness (8.5 vs. 1.9%), pain (18.1 vs. 5.6%) and instability (8.1 vs. 1.9%) were significantly higher in the patients who underwent delayed ACL reconstruction. Post‑operative rehabilitation was near‑universal (96.8%). Re‑tear and infection rates did not exhibit significant differences between the two groups. On the whole, the present study demonstrates that early ACL reconstruction (performed within 12 weeks of injury) leads to improved function, higher activity levels and fewer complications than delayed surgery. Despite longer pre‑operative rehabilitation in the cases undergoing delayed ACL reconstruction, early intervention is recommended, particularly for younger, active patients, with individualized decision‑making advised.