Most Anterior Cruciate Ligament Reconstructions Might Be Avoided

According to a new study, 60% of anterior cruciate ligament (ACL) operations could be avoided, without negatively affecting treatment outcomes.

Researchers at Lund University (Sweden), Helsingborg Hospital (Sweden), and Skåne University Hospital (Lund, Sweden) conducted a randomized, controlled trial involving 121 young, active adults with acute ACL injury, comparing two treatment strategies. The first involved structured rehabilitation with concomitant early ACL reconstruction, and the second involved structured rehabilitation with the option of a deferred ACL reconstruction, if needed. The primary outcome was the change from baseline to two years in the average score on four subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS4)--pain, symptoms, function in sports and recreation, and knee-related quality of life. 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 (TAS).

The results showed that the absolute change in the mean KOOS4 score from baseline to two 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; of the 59 patients assigned to rehabilitation plus optional delayed ACL reconstruction, 23 eventually underwent delayed ACL reconstruction, while the other 36 underwent rehabilitation alone. In all, there were no significant differences between the two treatment groups with respect to secondary outcomes or adverse events. The study was published in the July 22, 2010, issue of the New England Journal of Medicine (NEJM).

"Despite the fact that many of the patients were active sportsmen and women, we found no difference between the treatment groups in terms of knee function, activity level, or well-being two years after the injury,” said lead author Richard Frobell, Ph.D., and colleagues. "Neither did we find any difference in these respects when we compared those who were treated with rehabilitation alone with those who had an early operation.”

"There are almost 10,000 scientific publications addressing the ACL and 50% of these are about surgical treatment. However, none of these studies have shown that surgical reconstruction produces better results than rehabilitation alone,” said Professor Stefan Lohmander, M.D., Ph.D., of Lund University and Skåne University Hospital. "Despite this, we perform 3,000 cruciate ligament reconstructions a year in Sweden; in the USA there are 200,000 operations of this type, at a cost of US$3 billion.”

Related Links:
Lund University
Helsingborg Hospital
Skåne University Hospital