{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T03:02:35Z","timestamp":1789182155259,"version":"build-2803163510"},"reference-count":63,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T00:00:00Z","timestamp":1706745600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>The study\u2019s objective was to determine the optimal window for anterior cruciate ligament (ACL) reconstruction with respect to quadriceps atrophies and clinical outcome.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>For this retrospective, comparative study, 115 patients aged under 35 were included, who received an ACL reconstruction between 2011 and 2016. They were divided into four groups, depending on the time to surgery, to determine the optimal window for reconstruction: (group 1: \u226421 d, group 2: &lt;21d-56d\u2265, group 3: &gt;56d-100d\u2265, group 4: &gt;100d). Follow-up was performed one month postoperatively, after a mean of 4.9 (\u00b15.3) months, and after a mean of 3.5 (\u00b11.4) years. Primary endpoints included quadriceps muscle status, range of motion (ROM), pain, swelling, the International Knee Documentation Committee Subjective Knee Form (IKDC), the Lysholm-Score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Tegner-Activity-Scale (TAS).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Significantly more quadriceps atrophies were observed in group 1 and group 4, representing reconstructions earlier than 21 and later than 100 days (29% and 41% vs. 9%; p = 0.032). The measurements of knee extension (p = 0.082) and ROM (p = 0.123) were comparable in all groups. Group 1 showed the least pain (0% vs. 15%; p = 0.285) and swelling (0% vs. 23%; p = 0.077) compared to all other groups one month postoperatively. A comparison of postoperative clinical scores revealed no significant differences, with group 1 exhibiting the lowest TAS levels.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>In patients who underwent ACL reconstruction within three weeks or after more than 100 days, a significantly higher incidence of quadriceps atrophy was observed, possibly attributable to the initial inflammatory phase or the delayed reconstruction affecting quadriceps function. However, this impairment may not be observable in elite athletes who undergo reconstruction within hours of the injury.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0296943","type":"journal-article","created":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T18:44:54Z","timestamp":1706813094000},"page":"e0296943","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["The optimal window for reconstruction of the anterior cruciate ligament (ACL) with respect to quadriceps atrophies lies within 21 to 100 days"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9739-6176","authenticated-orcid":true,"given":"Harald K.","family":"Widhalm","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8344-7796","authenticated-orcid":true,"given":"Alexander","family":"Draschl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jannike","family":"Horns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Rilk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Leitgeb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Hajdu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Sadoghi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,2,1]]},"reference":[{"key":"pone.0296943.ref001","doi-asserted-by":"crossref","first-page":"2363","DOI":"10.1177\/0363546514542796","article-title":"Incidence and trends of anterior cruciate ligament reconstruction in the United States.","volume":"42","author":"NA Mall","year":"2014","journal-title":"Am J Sports Med"},{"key":"pone.0296943.ref002","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1097\/00005373-199112000-00014","article-title":"Epidemiology of acute knee injuries: a prospective hospital investigation","volume":"31","author":"AB Nielsen","year":"1991","journal-title":"J Trauma"},{"key":"pone.0296943.ref003","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1177\/0363546516629944","article-title":"Incidence of Anterior Cruciate Ligament Tears and Reconstruction: A 21-Year Population-Based Study.","volume":"44","author":"TL Sanders","year":"2016","journal-title":"Am J Sports Med."},{"key":"pone.0296943.ref004","doi-asserted-by":"crossref","first-page":"e0191414","DOI":"10.1371\/journal.pone.0191414","article-title":"Analysis of 500 anterior cruciate ligament reconstructions from a private institutional register.","volume":"13","author":"LA Costa","year":"2018","journal-title":"PLoS One."},{"key":"pone.0296943.ref005","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1177\/036354659702500511","article-title":"Early season anterior cruciate ligament tears. 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