Early or delayed anterior cruciate ligament reconstruction: Is one superior? A systematic review and meta-analysis.

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction is a rapidly developing orthopaedic field and an area of notable clinical equipoise. The optimal timing of surgery in an acute (< 3 weeks) or delayed (≥ 3 weeks) time frame remains unresolved with a 2010 meta-analysis concluding no difference between these two groups across multiple outcomes. In an era of evidence-based medicine, surgeons are still basing their decisions on when to operate on little more than anecdotal evidence and personal preference. Clear guidance is required to determine whether the timing of surgery can optimise outcomes in this largely young and active patient cohort. METHODS: A systematic literature search was performed in January 2018 of Embase, Medline and OpenGrey in accordance with (PRISMA) guidelines. A total of 658 articles were retrieved, with 6 suitable for inclusion, covering 576 ACL reconstructions. Four meta-analyses were performed assessing subjective measures of Tegner activity scale and Lysholm score, and objective measures of arthroscopically identified meniscal and chondral injury. Additional relevant outcome measures underwent narrative review. Study bias was assessed and reported using the Downs and Black checklist. RESULTS: A statistically significant difference of 0.39 points was found on the Tegner activity scale in favour of early surgery within 3 weeks (RR 0.39, CI 0.10, 0.67, p = 0.008). No statistically difference was found between groups for the patient-reported Lysholm score (RR - 0.18, CI - 2.40, 2.05, p = 0.17). There was no statistically significant difference between groups for intra-operative findings of meniscal lesions (RR 0.84, CI 0.66, 1.08, p = 0.17). A trend towards significance was observed for the incidence of chondral lesions in the early surgery group (RR 0.56, CI 0.31, 1.02, p = 0.06). All the studies were rated either fair or good on the Downs and Black checklist with no study excluded due to bias. CONCLUSIONS: Although there was a statistically significant result for the Tegner activity scale in favour of early surgery, the magnitude of the effect is unlikely to translate into any clinically meaningful difference. At present, there remains no clear evidence to determine superiority of acute/early or delayed reconstruction of a ruptured anterior cruciate ligament. Further research through methodologically robust randomised controlled trials or through the UK National Ligament Registry  may help to provide clearer guidance.

National survey to evaluate musuloskeletal health in retired professional ballet dancers in the United Kingdom.

OBJECTIVES: To explore the musculoskeletal health of retired professional ballet dancers in the United Kingdom (UK). DESIGN: Online national survey. PARTICIPANTS: Retired professional ballet dancers living in the UK. METHODS: The survey explored: what musculoskeletal injuries or diseases are experienced by retired professional ballet dancers; which anatomical regions were affected by musculoskeletal injuries or diseases in retired professional ballet dancers; whether ballet dancers were forced to retire from professional ballet due to musculoskeletal injuries or disease. RESULTS: Forty-six retired ballet dancers responded. Thirty-six percent (n = 17) of respondents reported retiring from ballet due to musculoskeletal injury. The median age when respondents retired from professional ballet was 29 years. The most common issues that caused people to retire were hip and back pain (25%; n = 9 respectively), followed by hamstring injuries, ankle injuries, cervical spine injuries, and anterior knee pain (13% respectively; n = 5). Ninety-one percent (n = 42) reported experiencing muscle and joint pain post-retirement. CONCLUSIONS: Musculoskeletal pain and disease was a problem for respondents in this study. Further investigation is needed to define the problem, so management can be examined. Comparing performance and training regimes to injury rates in professional dancers, and then following these cohorts into retirement, would increase knowledge on this population.