Aim Identify injury-related, patient-reported and treatment-related prognostic factors for 5-year outcomes in acutely ACL-ruptured individuals managed with early reconstruction plus exercise therapy, exercise therapy plus delayed reconstruction or exercise therapy alone.
Methods Exploratory analysis of the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) trial (ISRCTN84752559). Relationships between prognostic factors (baseline cartilage, meniscus and osteochondral damage, baseline extension deficit, baseline patient-reported outcomes, number of rehabilitation visits, graft/contralateral ACL rupture, non-ACL surgery and ACL treatment strategy) and 5-year Knee Injury and Osteoarthritis Outcome Score (KOOS) pain, symptoms, sport/recreation and quality of life (QOL) scores were explored using multivariable linear regression. Estimates were adjusted for sex, age, body mass index, preinjury activity level, education and smoking.
Results For all participants (n=118), graft/contralateral ACL rupture, non-ACL surgery and worse baseline 36-item Short-Form Mental Component Scores were associated with worse outcomes. Treatment with exercise therapy alone was a prognostic factor for less knee symptoms compared with early reconstruction plus exercise therapy (regression coefficient 10.1, 95% CI 2.3 to 17.9). Baseline meniscus lesion was associated with worse sport/recreation function (−14.4, 95% CI −27.6 to –1.3) and osteochondral lesions were associated with worse QOL (−12.3, 95% CI −24.3 to –0.4) following early reconstruction plus exercise therapy. In the same group, undergoing additional non-ACL surgery and worse baseline KOOS scores were prognostic for worse outcome on all KOOS subscales. Following delayed reconstruction, baseline meniscus damage was a prognostic factor for less pain (14.3, 95% CI 0.7 to 27.9). Following exercise therapy alone, undergoing non-ACL surgery was prognostic for worse pain.
Conclusions Treatment-dependent differences in prognostic factors for 5-year outcomes may support individualised treatment after acute ACL rupture in young active individuals.
Trial registration number Current Controlled Trials ISRCTN84752559.
- exercise therapy or rehabilitation
- arthroscopic surgery
- quality of life
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Contributors SRF, EMR and LSL conceived and designed this exploratory analysis. SRF, EMR, RBF, FR, JR and LSL participated in the analysis. SRF drafted the first version of the manuscript. All authors contributed in revising the manuscript and gave their final approval of the submitted version.
Funding The KANON study received funding from the Swedish Research Council (RBF, LSL, EMR), Medical Faculty of Lund University (RBF, LSL, EMR), Region Skåne (LSL, RBF, EMR), Thelma Zoegas Fund (RBF), Stig & Ragna Gorthon Research Foundation (RBF), Swedish National Centre for Research in Sports (LSL, RBF), Crafoord Foundation (RBF), Tore Nilsson Research Fund (RBF) and Pfizer Global Research (LSL). SRF was awarded an Osteoarthritis Research Society International young investigator scholarship to support this collaboration. The funders had no role in any part of the study or the decision to publish.
Competing interests EMR is deputy editor of Osteoarthritis and Cartilage, the developer of Knee injury and Osteoarthritis Outcome Score and founder of the Good Life with Osteoarthritis in Denmark initiative to implement clinical guidelines in primary care; FR is a shareholder of Boston Imaging Core Lab, outside the submitted work; JR reports personal fees from consultations, outside the submitted work. SRF, RBF and LSL have nothing to disclose.
Ethics approval Lund University Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
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