Vol. 11, Issue 3 (2025)

Background: Anterior cruciate ligament (ACL) injuries are common in active populations and can lead to joint instability, secondary cartilage damage, and long-term functional impairment. The timing of ACL reconstruction-early versus delayed remains controversial, with potential implications for post-operative complications and functional outcomes.
Aim of the study: To compare the incidence of early and late post-operative complications, as well as functional outcomes, in patients undergoing early (≤6 weeks) versus delayed (>12 weeks) ACL reconstruction.
Methods: This prospective comparative study was conducted from September 2022 to March 2025 in the Department of Orthopedic Surgery at BMU, Shahbagh, Dhaka. Forty-four patients with isolated ACL injuries were enrolled and divided into early (n=22) and delayed (n=22) reconstruction groups. Baseline demographic and clinical characteristics, post-operative complications (early ≤6 weeks and late >3 months), functional outcomes including Lysholm score, Tegner Activity Score, knee range of motion, return to pre-injury activity, and time to return to sport were assessed. Multivariate logistic regression was used to identify risk factors for complications.
Result: Baseline characteristics were comparable between groups. Early reconstruction was associated with lower incidences of early complications such as arthrofibrosis (9.09% vs. 4.55%) and hemarthrosis (4.55% vs. 13.64%), as well as late complications including residual pain (13.64% vs. 27.27%) and persistent instability (9.09% vs. 18.18%). Delayed surgery was identified as a significant independent risk factor for post-operative complications (adjusted OR = 2.10, 95% CI: 1.05-4.18, p = 0.03). Functional outcomes favored early reconstruction, with significantly higher Lysholm scores (90.1±3.8 vs. 82.5±8.7, p = 0.0008) and shorter time to return to sport (8.2±1.9 vs. 9.6±2.3 months, p = 0.033), while Tegner Activity Score and knee range of motion were similar between groups.
Conclusion: Early ACL reconstruction is associated with reduced post-operative complications, improved functional outcomes, and faster return to sport compared to delayed reconstruction. Timing of surgery is a critical determinant of surgical success, underscoring the benefits of early intervention in active patients.