Equivalent outcomes for ACL tears with early vs. delayed surgery

January 01, 0001

Equivalent outcomes for ACL tears with early vs. delayed surgery

These Danish and Swedish investigators conducted a randomized, controlled trial involving 121 young, active adults with acute anterior cruciate ligament (ACL) injury in which they compared two strategies: structured rehabilitation plus early ACL reconstruction and structured rehabilitation with the option of later ACL reconstruction if needed. The primary outcome was the change from baseline to 2 years in the average score on four subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS) — pain, symptoms, function in sports and recreation, and knee-related quality of life (KOOS4; range of scores, 0 =worst to 100 = best). Secondary outcomes included results on all five KOOS subscales, the Medical Outcomes Study 36- Item Short-Form Health Survey, and the score on the Tegner Activity Scale.

They found: "Of 62 subjects assigned to rehabilitation plus early ACL reconstruction, 1 did not undergo surgery. Of 59 assigned to rehabilitation plus optional delayed ACL reconstruction, 23 underwent delayed ACL reconstruction; the other 36 underwent rehabilitation alone. The absolute change in the mean KOOS4 score from baseline to 2 years was 39.2 points for those assigned to rehabilitation plus early ACL reconstruction and 39.4 for those assigned to rehabilitation plus optional delayed reconstruction. There were no significant differences between the two treatment groups with respect to secondary outcomes. Adverse events were common in both groups. The results were similar when the data were analyzed according to the treatment actually received."

The authors concluded: "In young, active adults with acute ACL tears, a strategy of rehabilitation plus early ACL reconstruction was not superior to a strategy of rehabilitation plus optional delayed ACL reconstruction. The latter strategy substantially reduced the frequency of surgical reconstructions."

It would have been helpful to provide outcome data for intermediate time periods such as 6,12, and 18 months.

For the full abstract, click here.

N Engl J Med 363(4):331-342, 22 July, 2010
© 2010 to the Massachusetts Medical Society
A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears. Richard B. Frobell, Ewa M. Roos, Harald P. Roos, Jonas Ranstam, and L. Stefan Lohmander. Correspondence to Dr. Frobell: [email protected]

Category: M. Musculoskeletal. Keywords: anterior cruciate ligament, reconstruction, rehabilitation, pain, quality of life, function, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 10 August 2010

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