Summary
Good clinical results with low prevalence of Osteoarthritis 13 years after acute ACL reconstruction in an RCT.
Abstract
Purpose
To compare long-term outcomes after acute ACL reconstruction (ACLR) performed within 8 days of injury, compared to delayed ACLR performed after normalized range of motion (ROM) 6–10 weeks after injury.
Methods
Study design: Randomized controlled trial.
Between 2006 and 2013, 70 young and active patients with an ACL injury were prospectively randomized into 2 groups: acute ACLR and delayed ACLR (1). The acute group underwent ACLR within 8 days of the injury, and the delayed group underwent ACLR after normalized range of motion (ROM) was achieved with rehabilitation, between 6 and 10 weeks. The aim of the study was to assess the risk of postoperative stiffness after acute ACLR, compared to with the traditional delayed ACLR. No such risk was found, and both groups had similar knee function evaluated with patient-reported outcome measures (PROMS) and clinical assessment at the 2-year follow-up (FU).
The patients were contacted and invited to participate in a FU to assess long-term knee function by PROMS, clinical assessment and radiological evaluation.
Results
Out of 70 randomized patients, 53 (76%) agreed to participate in the long-term FU at a mean of 13 years (SD±1.8) after the ACLR. Knee function was clinically assessed in 49 (70%) patients by a blinded experienced physiotherapist. The assessment showed no difference between the groups in terms of ROM, anterior knee laxity or isokinetic knee strength tests. PROMs were reported by 50 (71%) patients, and the KOOS symptoms scores were lower (p=0.023) for patients in the delayed group. No significant differences were found between the groups regarding the other subscales of the KOOS, Tegner’s activity level or Lysholm’s knee score. 44 patients (62%) were assessed with weightbearing knee x-rays, and the delayed group had a significantly higher proportion of patients with radiological signs of osteoarthritis (OA) (p=0.012). Further analysis of OA is ongoing and detailed results of both groups will be presented at the meeting.
Conclusion
The groups had similar outcome with only slight decrease of PROMs scores and few revisions at 13 years. Acute ACLR seems to be safe even for long-term outcome.
1. Eriksson K, von Essen C, Jönhagen S, Barenius B. No risk of arthrofibrosis after acute anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26: 2875-2882.