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Table 1 Summary of the included studies

From: A systematic review comparing the results of early vs delayed ligament surgeries in single anterior cruciate ligament and multiligament knee injuries

Study name Design Total no. of patients (criteria for early vs delayed) Combined ligament injury Combined meniscus injury (positive/negative) Combined cartilage injury (positive/negative) Clinical evaluation Overall Follow-up
Isolated ACL injury
 Chen et al., 2015 [14, 46] Retrospective review
Cross-sectional study
293
Early: 160 cases
Delayed: 133 cases
(0–6 months vs longer than 7 months)
Isolated ACL injury Early: Total: 86 cases/ MM tear: 42 cases/ LM tear: 44 cases
Delayed: Total: 109 cases/MM tear: 88 cases/ LM tear: 21 cases
Early: Total: 83 cases
Delayed: Total: 112 cases
Not reported Not reported
 Tandogan et al., 2004 [48] Retrospective study 764
Early: 510 cases
Delayed: 254 cases
(0–12 months vs more than 12 months)
Isolated ACL injury Total meniscus tear: 556 cases Early: 31 cases
Delayed: 55 cases
Not reported Not reported
 Manandhar et al., 2018 [40] Prospective study 104
Early: 53 cases
Delayed: 51 cases
(within 3 weeks vs after 6 weeks)
Isolated ACL injury Early: Total: 22 cases / LM tear: 12 cases / MM tear: 6 cases/ Both menisci torn: 4 cases
Delayed: Total: 34 cases /LM tear: 8 cases/ MM tear: 20 cases/ Both menisci torn: 6 cases
Early: 10 cases
Delayed: 28 cases
IKDC Early: 69.68 ± 8.14 vs delayed: 67.14 ± 6.08
Tegner Early 4.15 ± 1.45 vs delayed: 23.72 ± 1.34
Not reported
at least 24 weeks
 Meighan et al., 2003 [42] Retrospective study 31
Early: 13 cases
Delayed: 18 cases
(within 2 weeks vs between 8 and 12 weeks)
Isolated ACL injury Early: Total: 3 cases
Delayed: Total: 4 cases
Not reported Not reported 1 year
 Nikolic et al., 1998 [41] Retrospective study 182
Early: 66 cases
Delayed: 65 Excluded: 51 cases
(not reported, acute ACL vs ACL-deficient knee)
Isolated ACL injury Early: Total: 51 cases
Delayed: Total: 53 cases
Not reported Not reported Not reported
 Raviraj et al., 2010 [25] Retrospective study 99
Early: 51 cases
Delayed: 48 cases
(< 2 weeks vs 4–6 weeks)
Isolated ACL injury Early: Total: 38 cases/MM tear: 18 cases/ LM tear: 20 cases
Delayed: Total: 35 cases/ MM tear: 13 cases/ LM tear: 22 cases
Early: 29 cases
Delayed: 31 cases
Lysholm score: early 83.1 (80–90) vs delayed 84.2 (82–90)
Tegner activity score: early 6.1 (5 to 8) vs delayed 5.9 (5 to 8)
32 months (26–36)
 Hur et al., 2017 [38] Prospective study 91
Early: 48 cases
Delayed: 43 cases
(within 3 weeks vs more than 3 months)
Isolated ACL injury Early: Total: 25 cases/ MM tear: 14 cases/ LM tear: 15 cases
Delayed: Total: 27 cases/MM tear: 24 cases/ LM tear: 9 cases
Early: 15 cases, Delayed: 20 cases Lysholm: Early: 94.5 ± 8.9 Delayed: 96.3 ± 3.7
Tegner: Early: 6.0 ± 1.6 Delayed: 5.6 ± 1.5
Minimum 2 years
 Li et al., 2012 [39] Retrospective study 38
Early: 17 cases
Delayed: 21 cases
(< 3 weeks vs ≥ 3 weeks)
Isolated ACL injury Early: Total: 2 cases
Delayed: Total: 9 cases
Early: 0 cases, Delayed: 7 cases Lysholm: Early: 94.7 ± 9.3 Delayed: 92.2 ± 7.8
Tegner: Early: 6.6 ± 1.9 Delayed: .6.3 ± 1.3
Minimum 2 years
 Ahlen and Liden, 2011 [43] Prospective cohort study 61
Early: 30 cases
Delayed: 31 cases
(within 5 months vs More than 24 months)
Isolated ACL injury Early: Total: 15 cases/ MM tear: 4 cases/ LM tear: 9 cases
Delayed: Total: 20 cases/ MM tear: 14 cases/ LM tear: 2 cases
Early: 6 cases
Delayed: 9 cases
Not reported 25 months (18–43)
 Bottoni et al., 2008 [47] Prospective, randomized cohort study 70
Early: 35 cases
Delayed: 35 cases
(within 21 days vs beyond 6 weeks)
Isolated ACL injury Early: Total: 32 cases/MM tear: 14 cases/ LM tear: 18 cases
Delayed: Total: 24 cases/MM tear: 15 cases/LM tear: 9 cases
Early: 9 cases
Delayed: 5 cases
SANE: 83.1 vs 81.4
Lysholm: 80.6 vs 83.4
Tegner 5.8 vs 4.9
366 days (185–869)
 Chen et al., 2015 [14, 46] Prospective, randomized cohort study 55
Early: 27 cases
Delayed: 28 cases
(3–7 weeks vs 6–11 months)
Isolated ACL injury Not reported Not reported Lysholm: 47.26 / 93.37 / 95.04 vs 54.1 / 91.64 / 92.64
Tegner: 2.7 / 6.3 / 6.3 vs 2.5 / 6.1 / 6.3
IKDC: 20/6/1/0 vs 17/9/2/0
61 months
 Cipolla et al., 1995 [16] Retrospective review 770
Early: 218 cases
Delayed: 552 cases
(within 1 week vs later in different stages)
Isolated ACL injury Early: Total: 63 cases
Delayed: Total: 412 cases
Not reported Not reported Not reported
 Frobell et al., 2010 [45] Prospective cohort study 121
Early: 62 cases
Delayed: 59 cases
(less than 10 weeks vs more than 10 weeks)
Isolated ACL injury Early: Total 40 cases
Chronic: Total 50 cases
Not reported KOOS subscale
- pain: 87.2 vs 87.7
- symptoms: 78.7 vs 83.0
- daily function: 93.5 vs 94.7
- sports function: 71.8 vs 71.2
- QOL: 67.3 vs 63.0
SF-36
- physical: 82.1 vs 78.0
- mental: 88.3 vs 83.8
Tegner: 6.5 vs 5
24.6 months (24.4–24.7)
vs 25.0 months (24.7–25.2)
 Frobell et al., 2013 [44] Prospective cohort study (follow-up study of Frobell et al., 2010 [45]) 121
Early: 61 cases
Delayed: 59 cases
(less than 10 weeks vs more than 10 weeks)
Isolated ACL injury Early: Total 29 cases
Delayed: Total 32 cases
Not reported KOOS: 80 vs 82
KOOS subscale
- pain: 91 vs 91
- symptoms: 83 vs 87
- daily function: 95 vs 97
- sports function: 76 vs 79
- QOL: 71 vs 69
SF-36
- physical: 85 vs 84
- mental: 87 vs 85
Tegner: 4 vs 4
5 years
 Herbst et al., 2017 [23] Prospective cohort study 160
Early: 51 cases
Delayed: 55 cases
(within 48 h vs after 6 weeks)
Isolated ACL injury Early: MM tear: 8 cases/ LM tear: 14 cases/ Both menisci torn: 8 cases
Delayed: MM tear: 13 cases/ LM tear: 13 cases/ Both menisci torn: 4 cases
Not reported Tegner (isolated ACL): 6.7 ± 1.3 vs 6.3 ± 1.4
Tegner (with meniscus injury)
6.6 ± 1.3 vs 6.3 ± 1.5
24 months
 Fok et al., 2013 [37] Retrospective comparative study 150
Early: 97 cases
Delayed: 53 cases
(less than 12 months vs more than 12 months)
Isolated ACL injury Early: Total: 58 cases
Delayed: Total: 41 cases
Early: 40 cases
Delayed: 25 cases
IKDC: with meniscal injury 60.4 vs without 61.3
IKDC: with chondral lesion 60.1 vs without 61.3
IKDC: Red-red tear 56.7 vs red-white tear 62.1 vs white-white tear 60.1
Tegner score: preop (< 12 months) 3.92 vs preop (> 12 months 3.41)
Not reported
Multiligament injuries
 Krych et al., 2015 [58] Retrospective study 122
Early: 62 cases
Delayed: 60 cases
(within 3 months vs after 3 months)
KD I: 25
KD II:
KD III: 72
KD IV: 16
Early: 19 cases
Delayed: 21 cases
Total cartilage injury
52 (48.0%) / 70 (52.0%)
Not reported Not reported
 Tardy et al., 2017 [56] Retrospective study 39
Early: 22 cases
Delayed: 17 cases
(7–30 days vs after 3 months)
PMC vs PLC injury Early: 6 cases
Delayed: 7 cases
Not reported Objective IKDC:
PMC 2A, 16B,1C vs PLC 1A,13B,6C”
Subjective IKDC:
PMC 81 ± 15 vs PLC 70 ± 17″
Lysholm
PMC 89 ± 7 vs PLC 79 ± 11
Sports activity level
PMC: 8 at same level /10 decreased in activity level/1 stopped sports
PLC: 4 at same level/10 decreased in activity level/ 6 stopped sports
57 months (12–129)
 Moatshe et al., 2017 [59] Prospective cohort study 65
Early: 33 cases
Delayed: 32 cases
(less than 21 days vs more than 21 days)
KD I: 0
KD II: 4
KD III: 55
KD IV: 6
25 (38.5%) / 40 (61.5%) 25 (38.5%) / 40 (61.5%) Lysholm score
Early: 86.9 ± 15
Delayed: 81 ± 19
Tegner activity
Early: 4 ± 1.8/ Delayed: 4 ± 2
KOOS symptoms 78
KOOS pain 81
KOOS ADL 87
KOOS sport 54
KOOS QOL 64
Single leg hop test 88–93% of the uninjured leg
13.1 years (10–18.8 )
 Li et al., 2013 [51] Retrospective study 15
Early: 6 cases
Delayed: 9 cases
(< 3 weeks vs ≥3 weeks)
KD I: 0
KD II: 7
KD III: 8
KD IV: 0
Not reported Not reported Lysholm score
Early: 89.4 ± 4.4
Delayed: 82.1 ± 6.3
Tegner activity
Early: 3.9 / Delayed: 3.4
7.5 years (6–12)
 Liow et al., 2003 [8] Retrospective study 22
Early: 8 cases
Delayed: 14 cases
(< 2 weeks vs ≥2 weeks)
KD I: 7
KD II: 2
KD III: 11
KD IV: 0
Not reported Not reported Lysholm score
Early: 87 (81–91)
Delayed: 75 (53–100)
Tegner activity
Early: 5 / Delayed: 4.4
32 months (11–77)
 Noyes et al., 1997 [57] Retrospective study 11
Early: 7 cases
Delayed: 4 cases
(Early: mean 14 days
Delayed: mean 22 months)
Both cruciate ligaments torn: 10, All ligaments torn: 1 case Not reported Early: 0
Delayed: 3
Not reported 4.5 years
 Subbiah et al., 2011 [50] Retrospective study 19
Early: 11 cases
Delayed: 8 cases
(< 3 weeks vs ≥3 weeks)
KD I: 5
KD II: 3
KD III: 11
KD IV: 0
Total meniscus injury
16 (84%)/3 (16%)
Not reported Lysholm score
Early: 93.3 ± 6.6
Delayed: 90 ± 5.8
22 months (14–33)
 Wascher et al., 1999 [49] Retrospective study 13
Early: 9 cases
Delayed: 4 cases
(< 3 weeks vs ≥3 weeks)
ACL/PCL/MCL: 7 (53.8%)
ACL/PCL/PLC: 6 (46.2%)
Early: Total: 4 cases
Delayed: Total: 2 cases
Not reported Lysholm score
Early: 91.8 ± 7.1
Delayed: 79.3 ± 22.7
IKDC: 6 nearly normal (46.2%)
Meyers: 11 excellent or good (84.6%)
38 months
 Zhang et al., 2013 [52] Retrospective study 59
Early: 48 cases
Delayed: 11 cases
(< 3 weeks vs > 3 weeks)
ACL/PCL/MCL/PLC Not reported Not reported Lysholm score
Early: 87.6 ± 10.2
Delayed: 80.5 ± 13.3
2.5 years
 Tzurbakis et al., 2006 [10] Retrospective study 48
Early: 38 cases
Delayed: 10 cases
(within 3 weeks vs more than 3 weeks)
Group A (ACL + medial): 12 (25%)
Group B (cruciate + PLC): 11 (22.9%)
Group C (bicruciate + collateral): 25 (52.1%)
Total meniscus tear
MM: 20 (41.7%) / 28 (58.3%)
LM: 13 (27.1%) / 35 (72.9%)
Total cartilage injury
6 (12.5%) / 42 (87.5%)
Tegner: Early: 4.4 ± 2.1 Delayed: 5.2 ± 2.2
Lysholm: Early: 87 ± 12.3 Delayed: 81.7 ± 13.3
51.3 ± 29.9 months
(24–96)
 Harner et al., 2004 [9] Retrospective cohort study 31
Early: 19 cases
Delayed: 12 cases
(within 3 weeks vs more than 3 weeks)
ACL/PCL/MCL/PLC Not reported Not reported Lysholm: Early: 91 Delayed: 80
KOOS (daily): Early: 91 vs Delayed: 84
KOOS (sports): Early: 89 vs Delayed: 69
Meyers: Early: 16/19 vs Delayed: 7/12
44 M / minimum 2Y
 Owens et al., 2007 [54] Retrospective study 28
Early: 20 cases
Delayed: 8 cases
(within 14 days vs greater than 14 days)
ACL/PCL/MCL/PLC Total meniscus injury
14 (50%) / 14 (50%)
Not reported Lysholm score
Early: 91.2 ± 6.52
Delayed: 83.6 ± 7.3
48 months (13–82)
 Fanelli et al., 1996 [55] Retrospective study 21
Early: 13 cases
Delayed: 8 cases
(2–4 weeks vs 6 months–16 years)
All were PCL/PLC injuries Not reported Not reported Lysholm score
Early: 91.2 / Delayed: 91.6
Tegner: Early 5.2 / Delayed: 5.0
Minimum 24 months (24–54)
 Wajsfisz et al., 2014 [53] Retrospective study 53
Early: 10 cases
Delayed: 43 cases
(within 21 days vs more than 21 days)
Not reported Not reported Not reported Lysholm score
Early: 83 / Delayed: 76.5
49 months (12–146)
  1. ACL anterior cruciate ligament, MM medial meniscus, LM lateral meniscus, IKDC International Knee Documentation Committee, KOOS Knee Injury and Osteoarthritis Outcome Score, QOL quality of life, KD Schenck knee dislocation type, PMC posteromedial corner, PLC posterolateral corner, ADL activities of daily living, PCL posterior cruciate ligament, MCL medial collateral ligament