Rehab with optional later knee surgery works for ACL tears

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Patients who tried rehabilitation instead of immediately having surgery on their torn anterior cruciate ligaments (ACL) did as well as patients who had early ACL reconstruction, a new study found.

The randomized, controlled trial included 121 young, active Swedish adults with acute ACL injuries. The patients were assigned to either rehabilitation plus early ACL reconstruction or rehabilitation with the option of later ACL surgery if needed. Of the 59 patients in the latter group, 23 eventually had ACL reconstruction.

The primary outcomes of the study were knee pain, symptoms, function in sports and recreation and knee-related quality of life, compared at baseline and after two years. There were no significant differences between the groups' improvement on these outcomes, and an additional post hoc as-treated analysis also found no significant differences in outcomes among patients who got early reconstruction, late reconstruction or no surgery at all. The patients in the delayed surgery group were more likely to have surgery on the meniscus.

The study authors concluded that in this patient population, the strategy of early reconstruction with rehabilitation is not superior to rehabilitation with the option of delayed reconstruction. They noted that more than half of the potential reconstructions were avoided by employing the rehab with optional surgery strategy.

However, an accompanying editorial noted that two years of follow-up is insufficient to definitively determine the long-term effects of the strategy. The editorialist recommended that decisions about surgical reconstruction of ACLs be made based on the individual knee and patient. The study and editorial were published in the July 22 New England Journal of Medicine.