KANON 5-year

Republished research: treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial.

Frobell RB, Roos HP, Roos EM, et al. British journal of sports medicine 2013 · PMID 23525751 · doi:10.1136/bjsports-2013-f232rep

Question

Do the 2-year KANON findings hold at 5 years for patient-reported outcomes, meniscal surgery and radiographic osteoarthritis?

Design

Five-year follow-up of the KANON randomised controlled trial.

Patients

Young active adults originally randomised in KANON after acute ACL rupture.

Intervention

Early ACL reconstruction plus rehabilitation

Comparison

Rehabilitation with optional delayed reconstruction

Primary outcome

Change in KOOS4 from baseline to 5 years

Key result

At 5 years there was still no significant difference in KOOS4, other patient-reported outcomes or radiographic osteoarthritis between groups. About half of the rehabilitation-first group had still not needed reconstruction.

Limitations

Underpowered for differences in osteoarthritis or meniscal surgery rates; non-elite population limits generalisation to elite athletes.

Impact on practice

Reinforces that a rehabilitation-first strategy does not cause harm in the medium term and that early reconstruction does not prevent osteoarthritis.