ACL SNNAPLancet (London, England) 2022
Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial.
Reconstruction gave a statistically significantly better KOOS4 at 18 months than rehabilitation. Around two-fifths of the rehabilitation group went on to have reconstruction within 18 months, so most avoided surgery in that period.
Randomised trialManagementKnee soft tissue & sports
BMJ Rapid Recommendation knee arthroscopyBMJ (Clinical research ed.) 2017
Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline.
The panel made a strong recommendation against arthroscopic surgery for almost all patients with degenerative knee disease, as any benefit was very small and short-lived.
GuidelineManagementKnee soft tissue & sports
Kise exercise vs APMBritish journal of sports medicine 2016
Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up.
There was no clinically relevant or significant difference in KOOS4 at 2 years, and the exercise group had better thigh muscle strength in the short term.
Randomised trialManagementKnee soft tissue & sports
Cochrane patellar dislocationThe Cochrane database of systematic reviews 2015
Surgical versus non-surgical interventions for treating patellar dislocation.
Surgery was associated with a lower risk of recurrent dislocation, but the evidence was of low or very low quality and any difference in patient-reported function was uncertain.
Systematic review / meta-analysisManagementKnee soft tissue & sports
FIDELITYThe New England journal of medicine 2013
Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear.
Both groups improved, with no significant difference between partial meniscectomy and sham surgery for any primary outcome at 12 months, and no significant difference in subsequent knee surgery or serious adverse events.
Randomised trialManagementKnee soft tissue & sports
KANON 5-yearBritish journal of sports medicine 2013
Republished research: treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial.
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.
Randomised trialManagementKnee soft tissue & sports
KANONThe New England journal of medicine 2010
A randomized trial of treatment for acute anterior cruciate ligament tears.
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.
Randomised trialManagementKnee soft tissue & sports
Kirkley arthroscopy for knee OAThe New England journal of medicine 2008
A randomized trial of arthroscopic surgery for osteoarthritis of the knee.
Adding arthroscopic surgery gave no significant additional benefit in WOMAC score at 2 years over physical and medical therapy alone.
Randomised trialManagementKnee soft tissue & sports
Clinical tests for ACL rupture meta-analysisThe Journal of orthopaedic and sports physical therapy 2006
Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis.
The Lachman test had the best overall sensitivity for ACL rupture, while the pivot shift test was highly specific and useful for ruling the diagnosis in. The anterior drawer test performed better in chronic than acute injuries.
Systematic review / meta-analysisDiagnosisKnee soft tissue & sports
Ottawa knee rule validationJAMA 1996
Prospective validation of a decision rule for the use of radiography in acute knee injuries.
The rule identified all clinically important fractures in the validation cohort (sensitivity of 100%) and would have reduced the need for knee radiographs substantially.
Cohort studyDiagnosisKnee soft tissue & sports