Data from 22 articles (10 RCTs) spanning 3,583 patients was systematically reviewed to determine whether delayed anterior cruciate ligament (ACL) reconstruction produced more meniscal and chondral pathologies, contributing to an increased risk of osteoarthritis, when compared to early reconstruction. The analysis of the appropriate literature revealed that substantial variability existed between included studies in terms of study design, methodology, surgical technique involved, and outcome measurements. In particular, the definition of delayed and early intervention was not similar between studies. Eight articles supported early reconstruction, while the majority of the evidence demonstrated no difference in outcome based on the timing of surgery.