Study: Consider rehabilitation over immediate ACL reconstruction for young, active adults

The results of a level 1 study showed no significant differences in 5-year outcomes between patients who underwent rehabilitation and early ACL reconstruction and those who had rehabilitation and optional delayed ACL reconstruction.

“In this study, there was no increased risk of osteoarthritis or meniscal surgery if the ACL injury was treated with physiotherapy alone compared with if it was treated with surgery,” study researcher Richard B. Frobell, PhD, stated in a press release from Lund University. “Neither was there any difference in patients’ experiences of function, activity level, quality of life, pain, symptoms or general health.”

He added, “The new report shows that there was no difference in any outcome between those who were operated on straight away, those who were operated on later and those who did not have an operation at all. The message to the medical experts who are treating young, active patients with ACL injuries is that it may be better to start by considering rehabilitation rather than operating straight away.”

Frobell and colleagues studied 121 adult patients who were treated with rehabilitation. Of these, 62 patients were assigned to undergo immediate ACL reconstruction and 59 patients were given the option of later ACL reconstruction, according to the abstract. All patients received the same rehabilitation.

In the optional group, 30 patients underwent delayed ACL reconstruction during the 5-year follow-up. This group also showed a change from baseline to 5-year-follow-up of 44.9 in four of the five subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS4) compared to 42.9 in the early ACL reconstruction group, according to the study abstract.

The investigators found no significant differences between the groups regarding scores on the KOOS4, the KOOS subscales and Tegner activity scale at 5 years. They also found no significant differences between the groups for the incident radiographic osteoarthritis in the knee and the number of knees undergoing meniscus surgery, according to the study abstract.

Reference:

Frobell RB. BMJ. 2013;doi:10.1136/bmj.f232.

Disclosure: One or more of the authors received funding for this study from the Swedish Research Council, Medical Faculty of Lund University, Region Skåne, Thelma Zoegas Fund, Stig & Ragna Gorthon Research Foundation, Swedish National Centre for Research in Sports, Crafoord Foundation, Tore Nilsson Research Fund and Pfizer Global Research.