Objectives To determine development of new and worsening meniscal damage over 5 years after acute anterior cruciate ligament (ACL) injury comparing rehabilitation plus early ACL reconstruction (‘early-ACLR’) versus rehabilitation with optional delayed ACL reconstruction (‘optional-delayed-ACLR’).
Methods We used knee MRIs from the only randomised controlled trial in the field including 121 young adults. One musculoskeletal radiologist read baseline and 5-year follow-up images using the Anterior Cruciate Ligament Osteoarthritis Score (ACLOAS). We defined development (ie, new and worsening) of meniscal damage both dichotomously and as a sum score representing severity (based on the reclassified ACLOAS meniscus grades). In the full analysis set, we analysed development of meniscal damage (yes/no) with logistic regression and severity with zero-inflated Poisson regression and adjusted for age, sex and baseline meniscal damage.
Results Over 5 years, new or worsening meniscal damage developed in 45% of subjects with early-ACLR and in 53% of subjects with optional-delayed-ACLR. The relative risk for development of meniscal damage on knee level was 1.3 (95% CI 0.9 to 1.9) in optional-delayed-ACLR versus early-ACLR. For medial and lateral meniscal damage, respectively, the relative risks were 2.1 (95% CI 1.1 to 3.9) and 1.0 (95% CI 0.6 to 1.5). The mean severity score was 1.5 higher (more severe damage) on knee level in optional-delayed-ACLR versus early-ACLR (95% CI 1.1 to 1.9) among those with meniscal damage at 5 years. For medial and lateral meniscal damage, respectively, the corresponding scores were 1.7 (95% CI 1.2 to 2.5) and 1.1 (95% CI 0.8 to 1.4).
Conclusion A strategy of early-ACLR may reduce development of medial meniscal damage following acute ACL injury. For the lateral meniscus, ACLR seems neither to be protective nor to increase the risk of damage.
Trial registration number ISRCTN 84752559.
- randomised controlled trial
- knee surgery
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Contributors Barbara Snoeker takes responsibility for the integrity of the data and the accuracy of the data analysis. Barbara Snoeker and Aleksandra Turkiewicz performed statistical analyses. Barbara Snoeker drafted the manuscript. Frank Roemer, Aleksandra Turkiewicz, Richard Frobell, Stefan Lohmander, and Martin Englund contributed with acquisition of data, conceptual design, and analysis and interpretation of data. Barbara Snoeker, Frank Roemer, Aleksandra Turkiewicz, Richard Frobell, Stefan Lohmander, and Martin Englund contributed in drafting the article or critically revising it for important intellectual content. All authors gave final approval for the version to be submitted.
Funding The KANON study and this project received funding from The Swedish Research Council, Greta and Johan Kock Foundations, the Medical Faculty of Lund University, Region Skåne, Governmental funding of clinical research within the national health services (ALF), The Swedish Rheumatism Association, Thelma Zoegas Fund, The Stig & Ragna Gorthon Research Foundation, Swedish National Centre for Research in Sports, Crafoord Foundation, Tore Nilsson Research Fund and Pfizer Global Research.
Disclaimer Funding sources had no role in the design, collection and interpretation of the data or the decision to submit for publication.
Competing interests FWR, one of the coauthors, is Chief Medical Officer and shareholder of BICL, LLC.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement No data are available.