Greater proportion of patients report an acceptable symptom state after ACL reconstruction compared with non-surgical treatment: a 10-year follow-up from the Swedish National Knee Ligament Registry

Abstract

ObjectivesTo compare the proportion of patients with anterior cruciate ligament (ACL) injury reporting an acceptable symptom state, between non-surgical and surgical treatment during a 10-year follow-up.MethodsData were extracted from the Swedish National Knee Ligament Registry. Exceeding the Patient Acceptable Symptom State (PASS) for the Knee injury and Osteoarthritis Outcome Score (KOOS) was the primary outcome. The PASS and KOOS4 (aggregated KOOS without the activities of daily living (ADL) subscale) were compared cross-sectionally at baseline and 1, 2, 5 and 10 years after ACL injury, where patients treated non-surgically were matched with the maximum number of patients with ACL reconstruction for age, sex and activity at injury.ResultsThe non-surgical group consisted of 982 patients, who were each matched against 9 patients treated with ACL reconstruction (n=8,838). A greater proportion of patients treated with ACL reconstruction exceeded the PASS in KOOS pain, ADL, sports and recreation, and quality of life compared with patients treated non-surgically at all follow-ups. With respect to quality of life, significantly more patients undergoing ACL reconstruction achieved a PASS compared with patients receiving non-surgical treatment at all follow-ups except at baseline, with differences ranging between 11% and 25%; 1 year −25.4 (−29.1; −21.7), 2 years −16.9 (−21.2; −12.5), 5 years −11.0 (−16.9; −5.1) and 10 years −24.8 (−36.0; −13.6). The ACL-reconstructed group also reported statistically greater KOOS4 at all follow-ups.ConclusionA greater proportion of patients treated with ACL reconstruction report acceptable knee function, including higher quality of life than patients treated non-surgically at cross-sectional follow-ups up to 10 years after the treatment of an ACL injury.

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

“…Early reconstruction after ACL injury entails superior patient-reported outcome compared with both rehabilitations alone and later ACL reconstruction. 5 6 These findings are inconclusive, since there are studies reporting no differences between patients treated with rehabilitation alone or reconstruction in patient-reported outcomes in the long term (10–20 years) after ACL injury. 19 20 On the other hand, patients treated with ACL reconstruction can report persistent symptoms and dissatisfaction with treatment.…”

“…3 Recent cohort studies from the Scandinavian registers indicate that patients treated with rehabilitation alone generally report poorer knee function and achieve acceptable knee function to a lesser extent 1, 2, 5 and 10 years after the ACL injury, compared with patients treated with ACL reconstruction and subsequent rehabilitation. [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.…”

Scoping Review on ACL Surgery and Registry Data

“…Moreover, data from Kaiser Permanente's ACLR registry was recently used to identify differences in revision risk with respect to the timing of ACL-R [36] and concomitant meniscus surgery [37]. Importantly, data collection from non-operatively treated patients with ACL injury enables the comparison of outcomes following operative and non-operative treatment approaches [38,39].…”

“…During the past decades, ACL registries have generally provided an increased understanding of the associations between different patient characteristics and patient-reported outcomes as well as the risk of sustaining a second ACL injury. Also, the ACL registries, such as the Scandinavian ACL registries, have contributed to increased knowledge of outcomes following ACL injury, allowing improved understanding of the association between different treatment options and PROMs [3][4][5][6]. However, the evidence on how to treat patients that have sustained an ACL injury is still insufficient in terms of timing of surgery, graft type, and treatment type, showing the importance of further studies and continuous development of national ACL registries.…”

Sports

“…Another paper focusing on patient symptoms comes from Gothenburg (Sweden) . 3 There have been a number of randomized trials in arthroscopic knee surgery recently, including in anterior cruciate ligament (ACL) reconstruction, that do not resoundingly support surgery as the best option. Most of these reports are relatively small numbers of patients and rely on patient-reported outcome measures, usually at two or five years.…”