We get a lot questions from our listeners each week and they’re great questions,
so rather than responding individually we thought we’d do these mini episodes where highlight some of the best questions and our responses. So, let’s get started! Today’s Ask The Sports Docs focuses on timing of ACL reconstruction surgery.

Our patients, and their families, frequently ask… how long can I wait to
have the surgery? To answer that question, we’re going to review an article, hot off the press in this month’s issue of AJSM titled “Early ACL Reconstruction Mitigates the Development of Posttraumatic Osteoarthritis in a Murine ACL Rupture Model.” Dr. Julia Retzky and colleagues at HSS sought to answer the question:
Does the timing of ACL reconstruction actually matter for long-term joint health?

This is a timely paper because posttraumatic osteoarthritis or “PTOA” after ACL injury remains a massive unsolved problem. Even with modern reconstruction techniques, we’re still seeing 23 to 60% rates of PTOA at 10 to 25 years post-op. Historically, the literature on timing is all over the place. Some studies suggest early ACLR may reduce PTOA risk, others show no difference. The problem is
heterogeneity—different grafts, definitions of “early,” imaging versus radiographic OA, meniscal status, you name it.

And that’s where this paper is interesting. It strips away a lot of clinical confounders by using a controlled murine model (or mouse model) with a noninvasive closed ACL rupture, followed by either immediate reconstruction, delayed reconstruction, or no reconstruction. And importantly, this is the first murine study using a true intra-articular ACL reconstruction model, rather than extra-articular stabilization. So this mirrors what we do clinically, with a true anatomic ACL reconstruction.

So, let's dive in...

www.cloganmd.com / www.cosportsmedicine.com / https://orthopedicnj.com/physicians/ashley-bassett

163: Ask The Sports Docs: What is the Optimal Timing of ACL Surgery