Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial

Beard, David; Davies, Loretta; Cook, Jonathan; Stokes, Jamie R.; Leal, José; Fletcher, Heidi; Abram, Simon G F; Chegwin, Katie; Greshon, Akiko; Jackson, William F.; Bottomley, Nicholas; Dodd, Matthew C.; Bourke, Henry E.; Shirkey, Beverly A.; Páez, Arsenio; Lamb, Sarah E; Barker, Karen; Phillips, Michael J.; Brown, Mark T.; Lythe, Vanessa; Mirza, Burhan; Carr, Andrew; Monk, Paul; Areia, Carlos; O’Leary, S.; Haddad, Fares S.; Wilson, Chris; Price, Andrew

doi:10.1016/s0140-6736(22)01424-6

Cited by 48 publications

(28 citation statements)

References 26 publications

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“…For all other patients, primary physiotherapy with optional secondary surgery is recommended for patients with persistent functional instability (e.g., giving way). This recommendation is supported by a recent controlled randomized study that was able to show that ACL reconstruction as a treatment strategy for patients with non-acute ACL injuries with persistent symptoms of instability is clinically superior and more cost effective compared to conservative therapy [1].…”

Section: Scan Qr Code and Read Article Onlinementioning

confidence: 92%

Does non-surgical treatment after rupture of the anterior cruciate ligament lead to results that are as good as surgery?

Petersen

Eisenhart-Rothe

Tischer

et al. 2022

Knie J.

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Section: Scan Qr Code and Read Article Onlinementioning

confidence: 92%

Does non-surgical treatment after rupture of the anterior cruciate ligament lead to results that are as good as surgery?

Petersen

Eisenhart-Rothe

Tischer

et al. 2022

Knie J.

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“…This large randomized controlled trial (RCT) from Oxford (UK) and London (UK) on anterior cruciate ligament (ACL) injuries has been awaited for a number of years. 3…”

Section: Rehabilitation Versus Surgical Reconstruction For Anterior C...mentioning

confidence: 99%

“…This large randomized controlled trial (RCT) from Oxford (UK) and London (UK) on anterior cruciate ligament (ACL) injuries has been awaited for a number of years. 3 While there have been a number of smaller studies (many undertaken in Scandinavian countries), there has not been until recently a large pragmatic RCT examining the outcomes of physiotherapy versus reconstruction. This current trial deserves consideration by anyone involved in knee, sports, or trauma surgery.…”

Section: Rehabilitation Versus Surgical Reconstruction For Anterior C...mentioning

confidence: 99%

Knee

2022

Bone & Joint 360

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The December 2022 Knee Roundup360 looks at: Effect of physical therapy versus arthroscopic partial meniscectomy: the ESCAPE trial at five years; Patellofemoral arthroplasty or total knee arthroplasty: a randomized controlled trial; Rehabilitation versus surgical reconstruction for anterior cruciate ligament injury; End-stage knee osteoarthritis in Australia: the effect of obesity; Do poor patient-reported outcome measures at six months relate to knee revision?; What is the cost of nonoperative interventions for knee osteoarthritis?

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“…[4][5][6] Only three randomised controlled trials (RCTs) have analysed the differences in self-reported knee function between the treatment options. [7][8][9] The RCTs did not report any clinically relevant differences between the two treatment options concerning self-reported knee function, level of sport or the prevalence of subsequent osteoarthritis (OA) 2-5 years after baseline. [7][8][9][10] However, in these studies, [7][8][9] WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Up to 50% of patients who suffer an anterior cruciate ligament (ACL) injury are treated with rehabilitation alone.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9] The RCTs did not report any clinically relevant differences between the two treatment options concerning self-reported knee function, level of sport or the prevalence of subsequent osteoarthritis (OA) 2-5 years after baseline. [7][8][9][10] However, in these studies, [7][8][9] WHAT IS ALREADY KNOWN ON THIS TOPIC ⇒ Up to 50% of patients who suffer an anterior cruciate ligament (ACL) injury are treated with rehabilitation alone. There is a knowledge gap regarding the experiences of patients treated with rehabilitation alone after an ACL injury.…”

Section: Introductionmentioning

confidence: 99%

When context creates uncertainty: experiences of patients who choose rehabilitation as a treatment after an ACL injury

Piussi

Simonson

Kjellander³

et al. 2023

BMJ Open Sport Exerc Med

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Up to 50% of patients who suffer an anterior cruciate ligament (ACL) injury receive or opt for rehabilitation alone as initial treatment in Scandinavia. Knowledge of whether patients treated with rehabilitation alone after ACL injury are satisfied is lacking. This study aimed to explore the experiences of patients treated with rehabilitation alone after an ACL injury. Fourteen patients (35.9 (19–56) years old) who suffered an ACL injury treated with rehabilitation alone, a mean of 32 months before inclusion, were interviewed. The interview transcripts were analysed using qualitative content analysis with an inductive approach. The experiences of patients treated with rehabilitation after an ACL injury were summarised in one theme: ‘Is the grass greener on the other side? Context characterised by uncertainty’, supported by three main categories and nine subcategories. Uncertainty permeated the context of all levels of knee-related life following ACL injury: (1) in the past, patients felt uncertainty regarding treatment choices, (2) in the present, patients felt uncertainty regarding their physical capacity and knee self-efficacy, and (3) for the future, patients felt uncertainty regarding what might happen. With few exceptions, patients’ experiences after an ACL injury treated with rehabilitation alone are characterised by uncertainty regarding their physical function, psychological impairments and possible future limitation of knee function. Uncertainty is experienced by patients in the past, the present and the future. Patients experience the knee as a symptomatic obstacle and need to adapt the physical activity to the presence of symptoms.

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Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial

Cited by 48 publications

References 26 publications

Does non-surgical treatment after rupture of the anterior cruciate ligament lead to results that are as good as surgery?

Does non-surgical treatment after rupture of the anterior cruciate ligament lead to results that are as good as surgery?

Knee

When context creates uncertainty: experiences of patients who choose rehabilitation as a treatment after an ACL injury

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