Treatment for Acute Anterior Cruciate Ligament Tear in Young Active Adults

BackgroundAnterior cruciate ligament (ACL) injury of the knee is common in young active adults and often has severe sometimes lifelong consequences. The clinical management this remains debated. A prior trial early versus delayed optional ACL repair showed no differences outcomes at 2 years.MethodsWe present 11-year follow-up a randomized involving 121 (mean age 26yo, 74% male) with an acute sports-related tear. We compared patient-reported radiographic between those to receive reconstruction (ACLR) followed by exercise therapy (N=62) treated plus ACLR (N=59). primary end point 11 years was change from baseline mean four subscales Knee Injury Osteoarthritis Outcome Score (KOOS) — pain, symptoms, function sports recreation, knee-related quality life (KOOS4; range scores, 0 [worst] 100 [best]; minimal important change=9).ResultsIn all, 88% cohort up (53/62 vs. 54/59 late groups), 52% assigned underwent ACLR. Mean improvement KOOS4 46 points for 45 (between-group difference, 1.6 points; 95% confidence interval [CI], −8.8 5.6; P=0.67 after adjustment score, full analysis set). About two thirds reported meeting case definition “patient-acceptable symptom state” (KOOS4 patient-acceptable state threshold value=79), whereas 44% had developed osteoarthritis their injured knee. summed incident feature scores 30 where higher indicate more joint damage, were 2.4 group 1.0 1.0; CI, 0.1 1.9).ConclusionsAt follow-up, among tears initial option ACLR, there outcomes. (Funded Swedish Research Council; ISRCTN number, ISRCTN84752559.)