A randomized trial of treatment for acute anterior cruciate ligament tears.
Frobell RB, Roos EM, Roos HP, et al. The New England journal of medicine 2010 · PMID 20660401 · doi:10.1056/nejmoa0907797
- Question
- In young active adults with an acute ACL tear, does early reconstruction plus rehabilitation give better outcomes than structured rehabilitation with the option of later reconstruction?
- Design
- Single-centre (Sweden) randomised controlled trial with 2-year follow-up.
- Patients
- Young, active, non-elite adults with an acute ACL rupture of the knee.
- Intervention
- Structured rehabilitation plus early ACL reconstruction
- Comparison
- Structured rehabilitation with optional delayed reconstruction if symptomatic instability developed
- Primary outcome
- Change in KOOS4 (average of four KOOS subscales) from baseline to 2 years
- Key result
- There was no significant difference in KOOS4 change at 2 years between the two strategies; around 40% of the rehabilitation-first group had delayed reconstruction, so most avoided surgery without a worse outcome.
- Limitations
- Excluded elite athletes and was single-centre, and patients were not blinded; a substantial crossover to delayed surgery complicates interpretation.
- Impact on practice
- Supports offering high-quality rehabilitation first, with reconstruction reserved for those with persisting instability, in non-elite patients with acute ACL rupture.