In a follow-up of a randomized controlled trial, a strategy of rehabilitation plus early acute anterior cruciate ligament (ACL) reconstruction did not provide better results at 5 years than a strategy of initial rehabilitation with the option of having a later ACL reconstruction. Results did not differ between knees surgically reconstructed early or late and those treated with rehabilitation alone. These results should encourage clinicians and young active adult patients to consider rehabilitation as a primary treatment option after an acute ACL tear, say the authors in their article published this month in BMJ. 

This study included 121 young, active adults (mean age 26 years) with acute ACL injury to a previously uninjured knee. All patients received similar structured rehabilitation. In addition to rehabilitation, 62 patients were assigned to early ACL reconstruction and 59 were assigned to the option of having a delayed ACL reconstruction if needed. One patient was lost to 5-year follow-up.

The main outcome was the change from baseline to 5 years in the mean value of 4 of the 5 subscales of the knee injury and osteoarthritis outcome score (KOOS₄). Other outcomes included the absolute KOOS(4) score, all 5 KOOS subscale scores, SF-36, Tegner activity scale, meniscal surgery, and radiographic osteoarthritis at 5 years.

Thirty (51%) patients assigned to optional delayed ACL reconstruction had delayed ACL reconstruction (7 between 2 and 5 years). The mean change in KOOS₄ score from baseline to 5 years was 42.9 points for those assigned to rehabilitation plus early ACL reconstruction and 44.9 for those assigned to rehabilitation plus optional delayed reconstruction (between group difference 2.0 points after adjustment for baseline score). At 5 years, no significant between-group differences were seen in KOOS₄, any of the KOOS subscales, SF-36, Tegner activity scale, or incident radiographic osteoarthritis of the index knee. No between-group differences were seen in the number of knees having meniscus surgery or in a time-to-event analysis of the proportion of meniscuses operated on. The results were similar when analyzed by treatment actually received.