Approaches for ACL Injuries Linked to Similar Outcomes

Study compares rehab plus early or optional delayed surgery for ligament injuries

WEDNESDAY, July 21 (HealthDay News) -- Among young, physically active adults with acute anterior cruciate ligament (ACL) tears, rehabilitation with optional delayed ligament reconstruction is associated with similar outcomes as rehabilitation plus early reconstruction, and it reduces the rate of reconstruction, according to research published in the July 22 issue of the New England Journal of Medicine.

Richard B. Frobell, Ph.D., of Lund University in Sweden, and colleagues analyzed data from 121 young adults with acute ACL injuries. Patients were randomized to structured rehabilitation plus either early ACL reconstruction or delayed reconstruction if needed. The primary outcome was change in the average score on four subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS) from baseline to two years: pain, symptoms, function in sports and recreation, and knee-related quality of life.

Of 62 individuals in the rehabilitation plus early reconstruction group, one did not have surgery. Of 59 assigned to rehabilitation plus optional delayed reconstruction, 36 did not have surgery. The researchers found that the absolute change in mean KOOS score was similar in the two groups (39.2 with early reconstruction and 39.4 with optional delayed). The groups weren't significantly different on secondary outcomes, and serious adverse events involving the index knee were similar in frequency and common in both groups.

"Given that no two patients and no two ACL injuries are identical, it is extremely difficult to recommend a single treatment strategy for all patients with ACL injuries," writes the author of an accompanying editorial. "It is difficult to predict which patients will have symptoms of instability that require surgery, and longer-term data are needed to truly understand the benefits and consequences of each of the two strategies described in this study."

Pfizer Global Research supported the study with a grant, and a study author reported financial ties to Pfizer.

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