A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears
In this randomized, controlled trial of young, active adults with an acute anterior cruciate ligament (ACL) injury, rehabilitation plus early ACL reconstruction was not superior to rehabilitation plus optional delayed ACL reconstruction with respect to pain, symptoms, knee function, and knee-related...
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| Published in | The New England journal of medicine Vol. 363; no. 4; pp. 331 - 342 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Waltham, MA
Massachusetts Medical Society
22.07.2010
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0028-4793 1533-4406 1533-4406 |
| DOI | 10.1056/NEJMoa0907797 |
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| Abstract | In this randomized, controlled trial of young, active adults with an acute anterior cruciate ligament (ACL) injury, rehabilitation plus early ACL reconstruction was not superior to rehabilitation plus optional delayed ACL reconstruction with respect to pain, symptoms, knee function, and knee-related quality of life, and it resulted in significantly more knee reconstructions.
Rupture of the anterior cruciate ligament (ACL) is a serious knee injury that affects mainly physically active young people. The injury is characterized by joint instability that leads to decreased activity, unsatisfactory knee function, and poor knee-related quality of life in the short term,
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and it is associated with an increased risk of osteoarthritis of the knee.
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Surgical reconstruction of the torn ligament has been regarded as critical for a good outcome and is commonly performed, particularly in those wishing to resume sports activities.
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Despite a lack of evidence from high-quality randomized, controlled trials comparing ACL reconstruction . . . |
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| AbstractList | In this randomized, controlled trial of young, active adults with an acute anterior cruciate ligament (ACL) injury, rehabilitation plus early ACL reconstruction was not superior to rehabilitation plus optional delayed ACL reconstruction with respect to pain, symptoms, knee function, and knee-related quality of life, and it resulted in significantly more knee reconstructions.
Rupture of the anterior cruciate ligament (ACL) is a serious knee injury that affects mainly physically active young people. The injury is characterized by joint instability that leads to decreased activity, unsatisfactory knee function, and poor knee-related quality of life in the short term,
1
,
2
and it is associated with an increased risk of osteoarthritis of the knee.
3
Surgical reconstruction of the torn ligament has been regarded as critical for a good outcome and is commonly performed, particularly in those wishing to resume sports activities.
2
,
4
,
5
Despite a lack of evidence from high-quality randomized, controlled trials comparing ACL reconstruction . . . Background The optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown. Methods We conducted a randomized, controlled trial involving 121 young, active adults with acute ACL injury in which we 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. Results 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 (absolute between-group difference, 0.2 points; 95% confidence interval, -6.5 to 6.8; P=0.96 after adjustment for the baseline score). 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. Conclusions 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. (Funded by the Swedish Research Council and the Medical Faculty of Lund University and others; Current Controlled Trials number, ISRCTN84752559 .) The optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown. We conducted a randomized, controlled trial involving 121 young, active adults with acute ACL injury in which we 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 (KOOS(4); 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. 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 KOOS(4) 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 (absolute between-group difference, 0.2 points; 95% confidence interval, -6.5 to 6.8; P=0.96 after adjustment for the baseline score). 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. 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. (Funded by the Swedish Research Council and the Medical Faculty of Lund University and others; Current Controlled Trials number, ISRCTN84752559.) BACKGROUND: The optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown. METHODS: We conducted a randomized, controlled trial involving 121 young, active adults with acute ACL injury in which we 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 (KOOS(4); 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. RESULTS: 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 KOOS(4) 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 (absolute between-group difference, 0.2 points; 95% confidence interval, -6.5 to 6.8; P=0.96 after adjustment for the baseline score). 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. CONCLUSIONS: 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. (Funded by the Swedish Research Council and the Medical Faculty of Lund University and others; Current Controlled Trials number, ISRCTN84752559.) The optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown.BACKGROUNDThe optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown.We conducted a randomized, controlled trial involving 121 young, active adults with acute ACL injury in which we 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 (KOOS(4); 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.METHODSWe conducted a randomized, controlled trial involving 121 young, active adults with acute ACL injury in which we 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 (KOOS(4); 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.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 KOOS(4) 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 (absolute between-group difference, 0.2 points; 95% confidence interval, -6.5 to 6.8; P=0.96 after adjustment for the baseline score). 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.RESULTSOf 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 KOOS(4) 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 (absolute between-group difference, 0.2 points; 95% confidence interval, -6.5 to 6.8; P=0.96 after adjustment for the baseline score). 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.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. (Funded by the Swedish Research Council and the Medical Faculty of Lund University and others; Current Controlled Trials number, ISRCTN84752559.)CONCLUSIONSIn 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. (Funded by the Swedish Research Council and the Medical Faculty of Lund University and others; Current Controlled Trials number, ISRCTN84752559.) Background: The optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown. Methods: We conducted a randomized, controlled trial involving 121 young, active adults with acute ACL injury in which we 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 (KOOS 4; 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. Results: 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 KOOS 4 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 (absolute between group difference, 0.2 points; 95% confidence interval, -6.5 to 6.8; P =0.96 after adjustment for the baseline score). 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. Conclusions: 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. |
| Author | Ranstam, Jonas Roos, Harald P Lohmander, L. Stefan Roos, Ewa M Frobell, Richard B |
| Author_xml | – sequence: 1 givenname: Richard B surname: Frobell fullname: Frobell, Richard B – sequence: 2 givenname: Ewa M surname: Roos fullname: Roos, Ewa M – sequence: 2 givenname: Harald P surname: Roos fullname: Roos, Harald P – sequence: 4 givenname: Jonas surname: Ranstam fullname: Ranstam, Jonas – sequence: 5 givenname: L. Stefan surname: Lohmander fullname: Lohmander, L. Stefan |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23024861$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/20660401$$D View this record in MEDLINE/PubMed |
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| CODEN | NEJMAG |
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| Snippet | In this randomized, controlled trial of young, active adults with an acute anterior cruciate ligament (ACL) injury, rehabilitation plus early ACL... The optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown. We conducted a randomized, controlled trial involving 121 young,... Background The optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown. Methods We conducted a randomized, controlled trial... The optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown.BACKGROUNDThe optimal management of a torn anterior cruciate ligament... Background: The optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown. Methods: We conducted a randomized, controlled trial... BACKGROUND: The optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown. METHODS: We conducted a randomized, controlled trial... |
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| SubjectTerms | Adolescent Adult Analysis of Variance Anterior Cruciate Ligament - surgery Anterior Cruciate Ligament Injuries Biological and medical sciences Clinical Medicine Combined Modality Therapy Data collection Female General aspects Humans Joint Instability Klinisk medicin Knee Knee Injuries - rehabilitation Knee Injuries - surgery Ligaments Male Medical and Health Sciences Medical sciences Medicin och hälsovetenskap Orthopaedics Ortopedi Physical therapists Reconstructive Surgical Procedures Rupture - rehabilitation Rupture - surgery Sports injuries Time Factors Treatment Outcome Young Adult |
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| Title | A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears |
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