ReviewOrthopaedic journal of sports medicine2026
Impact of Diabetes Mellitus on Complications and Revision Risk After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.
Review in Orthopaedic journal of sports medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
6 authors.
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Abstract
Background: As indications for anterior cruciate ligament reconstruction (ACLR) expand to older and more metabolically comorbid patients, diabetes mellitus (DM) has emerged as a potential determinant of surgical outcomes. However, existing evidence remains fragmented, with limited pooled data quantifying postoperative risk. Purpose/Hypothesis: The purpose was to systematically review evidence comparing postoperative complications between patients with and without DM undergoing ACLR. It was hypothesized that DM would be associated with an increased incidence of overall complications, but not of revision. Study Design: Systematic review and meta-analysis; Level of evidence, 3. Methods: The PubMed, Embase, Web of Science, and Scopus databases were searched through March 2025 following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analysis Of Observational Studies in Epidemiology) guidelines. Observational studies reporting postoperative outcomes in patients with and without DM undergoing ACLR were included. Pooled risk ratios (RRs) with 95% CIs were calculated using fixed- or random-effects models, as appropriate. The primary outcome was revision, and secondary outcomes included infection, surgical-site infection (SSI), readmission, and venous thromboembolism (VTE). For studies with zero events in 1 arm, a continuity correction of 0.5 was applied to enable computation of pooled estimates and avoid division-by-zero errors. Risk of bias assessment across included studies was conducted using the Risk of Bias Assessment tool for Non-randomized Studies of Interventions Version 2. Results: A total of 25 studies met the inclusion criteria. Compared with patient without DM, those with DM had significantly higher risks of postoperative infection (after sensitivity analysis, RR, 7.25 [95% CI, 3.07-17.08]; Conclusion: DM is associated with substantially increased risks of infection, SSI, readmission, and VTE after ACLR, although there was no significant difference in revision rates. These findings highlight the need for optimized perioperative strategies, including strict glycemic control, thoughtful graft selection, and tailored surgical protocols to improve safety and outcomes in patients with DM. Registration: CRD420251119493.
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