Clinical, Functional, and Physical Activity Outcomes 5 Years Following the Treatment Algorithm of the Delaware-Oslo ACL Cohort Study

Abstract

Background:Anterior cruciate ligament (ACL) injuries can be treated with or without ACL reconstruction (ACLR), and more high-quality studies evaluating outcomes after the different treatment courses are needed. The purpose of the present study was to describe and compare 5-year clinical, functional, and physical activity outcomes for patients who followed our decision-making and treatment algorithm and chose (1) early ACLR with preoperative and postoperative rehabilitation, (2) delayed ACLR with preoperative and postoperative rehabilitation, or (3) progressive rehabilitation alone. Early ACLR was defined as that performed ≤6 months after the preoperative rehabilitation program, and late ACLR was defined as that performed >6 months after the preoperative rehabilitation program.Methods:We included 276 patients from a prospective cohort study. The patients had been active in jumping, pivoting, and cutting sports before the injury and sustained a unilateral ACL injury without substantial concomitant knee injuries. The patients chose their treatment through a shared decision-making process. At 5 years, we assessed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale, sports participation, quadriceps muscle strength, single-legged hop performance, and new ipsilateral and contralateral knee injuries.Results:The 5-year follow-up rate was 80%. At 5 years, 64% of the patients had undergone early ACLR, 11% had undergone delayed ACLR, and 25% had had progressive rehabilitation alone. Understandably, the choices that participants made differed by age, concomitant injuries, symptoms, and predominantly level-I versus level-II preinjury activity level. There were no significant differences in any clinical, functional, or physical activity outcomes among the treatment groups. Across treatment groups, 95% to 100% of patients were still active in some kind of sports and 65% to 88% had IKDC-SKF and KOOS scores above the threshold for a patient acceptable symptom state.Conclusions:Patients with ACL injury who were active in jumping, pivoting, and cutting sports prior to injury; who had no substantial concomitant knee injuries; and who followed our decision-making and treatment algorithm had good 5-year knee function and high sport participation rates. Three of 4 patients had undergone ACLR within 5 years. There were no significant differences in any outcomes among patients treated with early ACLR, delayed ACLR, or progressive rehabilitation alone.Level of Evidence:Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Low Rates of Radiographic Knee Osteoarthritis 5 Years After ACL Reconstruction or Rehabilitation Alone: The Delaware-Oslo ACL Cohort Study

“…Follow-up was 5 years after completion of preoperative rehabilitation or ACLR. Clinical, functional, and physical activity outcomes at 2 years 11,17,18 and 5 years 43 have been reported previously.…”

“…Following our decision-making and treatment algorithm, we have previously reported excellent 5-year clinical, functional, and physical activity outcomes with no statistically significant differences among the management groups. 43 To our knowledge, this is the first study to compare 5-year radiographic outcomes following a specific treatment algorithm where management was chosen based on shared decision-making. As in clinical practice, different patients choose and are recommended different managements, which increases the external validity of our study.…”

“…We have previously reported no statistically significant differences in the 5-year clinical, functional, and physical activity outcomes between patients treated with early ACLR, delayed ACLR, or progressive rehabilitation alone. 43 As the processes leading to knee OA start long before radiographic changes are evident, 12,38 measures of established OA do not sufficiently detect early OA development. Different criteria for defining early knee OA with and without radiological findings have been proposed without reaching a consensus, but knee pain is frequently included in previous definition proposals [33][34][35]49 and is often the first sign of knee OA.…”

RetroBRACE: clinical, socioeconomic and functional–biomechanical outcomes 2 years after ACL repair and InternalBrace augmentation in comparison to ACL reconstruction and healthy controls—experimental protocol of a non-randomised single-centre comparative study

“…However, proprioception and joint position sense are not fully restored after ACL-R and this particular deficit might increase the risk of further injuries to the knee joint11 and potentially the premature development of tibiofemoral osteoarthritis 12. Although it has been reported that progressive rehabilitation alone after ACL injury may lead to good clinical and functional outcomes,13 14 preserving the native ACL with its nerve endings and vessels may also preserve proprioception 15. This may be beneficial regarding the postoperative rehabilitation, postoperative strength, return to work and sports as well as long-term joint degeneration.…”

Four Distinct 5-Year Trajectories of Knee Function Emerge in Patients Who Followed the Delaware-Oslo ACL Cohort Treatment Algorithm

“…We included patients early after injury, before a 5-week rehabilitation program and shared decision-making process about treatment. Following our treatment algorithm, we have previously reported equivalent 2-year and 5-year clinical, functional, physical activity, and radiographic outcomes after progressive rehabilitation alone, early ACL reconstruction (ACLR), and delayed ACLR 13 , 33 , 34 and assessed prognostic factors for short-term outcomes. 15 , 26 , 27 , 37 …”