Early surgical reconstruction versus rehabilitation with elective delayed reconstruction for patients with anterior cruciate ligament rupture: COMPARE randomised controlled trial

Autor: Duncan E. Meuffels, Eline M. van Es, Igor C.J.B. van den Brand, Jacco A. C. Zijl, E. Waarsing, Joost van Linge, Ewoud R.A. van Arkel, Max Reijman, Sita M A Bierma-Zeinstra, Vincent Eggerding
Přispěvatelé: Orthopedics and Sports Medicine, General Practice
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Adult
Male
medicine.medical_specialty
Adolescent
Anterior cruciate ligament
medicine.medical_treatment
Psychological intervention
Conservative Treatment
law.invention
Time-to-Treatment
03 medical and health sciences
Young Adult
0302 clinical medicine
Randomized controlled trial
law
Medicine
Humans
Patient Reported Outcome Measures
Young adult
Anterior cruciate ligament rupture
Aged
030222 orthopedics
Rehabilitation
Anterior Cruciate Ligament Reconstruction
business.industry
Research
Anterior Cruciate Ligament Injuries
030229 sport sciences
General Medicine
Delayed reconstruction
Recovery of Function
Middle Aged
musculoskeletal system
Confidence interval
Surgery
Return to Sport
medicine.anatomical_structure
Treatment Outcome
Elective Surgical Procedures
Female
business
human activities
Follow-Up Studies
Zdroj: The BMJ
BMJ-British medical journal, 372:n375. BMJ Publishing Group
ISSN: 1756-1833
0959-8138
Popis: Objective To assess whether a clinically relevant difference exists in patients’ perceptions of symptoms, knee function, and ability to participate in sports over a period of two years after rupture of the anterior cruciate ligament (ACL) between two commonly used treatment regimens. Design Open labelled, multicentre, parallel randomised controlled trial (COMPARE). Setting Six hospitals in the Netherlands, between May 2011 and April 2016. Participants Patients aged 18 to 65 with an acute rupture of the ACL, recruited from six hospitals. Patients were evaluated at three, six, nine, 12, and 24 months. Interventions 85 patients were randomised to early ACL reconstruction and 82 to rehabilitation followed by optional delayed ACL reconstruction after a three month period (primary non-operative treatment). Main outcomes Patients’ perceptions of symptoms, knee function, and ability to participate in sporting activities were assessed with the International Knee Documentation Committee score (optimum score 100) at each time point over 24 months. Results Between May 2011 and April 2016, 167 patients were enrolled in the study and randomised to one of two treatments (mean age 31.3; 67 (40.%) women), and 163 (98%) completed the trial. In the rehabilitation and optional delayed ACL reconstruction group, 41 (50%) patients underwent reconstruction during follow-up. After 24 months, the early ACL reconstruction group had a significantly better (P=0.026) but not clinically relevant International Knee Documentation Committee score (84.7 v 79.4 (difference between groups 5.3, 95% confidence interval 0.6 to 9.9). After three months of follow-up, the International Knee Documentation Committee score was significantly better (P=0.002) for the rehabilitation and optional delayed ACL reconstruction group (difference between groups −9.3, −14.6 to −4.0). After nine months of follow-up, the difference in the International Knee Documentation Committee score changed in favour of the early ACL reconstruction group. After 12 months, differences between the groups were smaller. In the early ACL reconstruction group, four re-ruptures and three ruptures of the contralateral ACL occurred during follow-up versus two re-ruptures and one rupture of the contralateral ACL in the rehabilitation and optional delayed ACL reconstruction group. Conclusions In patients with acute rupture of the ACL, those who underwent early surgical reconstruction, compared with rehabilitation followed by elective surgical reconstruction, had improved perceptions of symptoms, knee function, and ability to participate in sports at the two year follow-up. This finding was significant (P=0.026) but the clinical importance is unclear. Interpretation of the results of the study should consider that 50% of the patients randomised to the rehabilitation group did not need surgical reconstruction. Trial registration Netherlands Trial Register NL 2618.
Databáze: OpenAIRE
Externí odkaz: