The Delaware‐Oslo ACL Cohort treatment algorithm yields superior outcomes to usual care 9–12 years after anterior cruciate ligament reconstruction

Abstract

PurposePatient‐reported outcomes were compared between participants who followed the treatment algorithm of the Delaware‐Oslo ACL Cohort, consisting of progressive preoperative and postoperative rehabilitation, patient education, clinical testing and shared decision‐making about treatment choice, and those who followed usual care 9–12 years after anterior cruciate ligament reconstruction (ACLR).MethodsParticipants with primary ACLR were included from the Norwegian arm of the Delaware‐Oslo ACL Cohort and the Norwegian Knee Ligament Registry (usual care). The Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale scores and the International Knee Documentation Committee‐Subjective Knee Form (IKDC‐SKF) scores were compared. KOOS scores for the usual care group were converted to IKDC‐SKF scores with recently published validated crosswalk. The percentages of participants with scores above predefined thresholds for patient acceptable symptom state (PASS) were also calculated.ResultsEighty of 100 (80%) participants from the Delaware‐Oslo ACL Cohort and 1588 of 3248 (49%) from the usual care group participated in the follow‐up. Participants from the Delaware‐Oslo ACL Cohort had higher KOOS subscale (p < 0.001) and IKDC‐SKF scores (p < 0.001), and a higher percentage reached PASS (84%–96% vs. 62%–76%, p ≤ 0.002) for KOOS Pain, symptoms, activities of daily living and sports compared to the usual care group. No significant differences were found for KOOS quality of life scores (not significant [n.s.]) or PASS percentages (80% vs. 74%, n.s.).ConclusionParticipants with ACLR who followed the Delaware‐Oslo ACL Cohort treatment algorithm had reduced knee symptoms, superior function and higher percentages of satisfactory outcomes than participants who followed usual care.Level of EvidenceLevel II.