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Meniscal procedures are not increased with delayed ACL reconstruction and rehabilitation: results from a randomised controlled trial
  1. Sabine J A van der Graaff1,
  2. Max Reijman1,
  3. Eline M van Es1,
  4. Sita M A Bierma-Zeinstra2,
  5. Jan A N Verhaar1,
  6. Duncan E Meuffels1
  1. 1Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
  2. 2Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
  1. Correspondence to Dr Duncan E Meuffels, Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, 3015 GD, The Netherlands; d.meuffels{at}erasmusmc.nl

Abstract

Objective To assess whether initial non-operative treatment of anterior cruciate ligament (ACL) ruptures with optional delayed ACL reconstruction leads to more meniscal procedures compared with early ACL reconstruction during the 2-year follow-up.

Methods We compared the number of meniscal procedures of 167 patients with an ACL rupture, who either received early ACL reconstruction (n=85) or rehabilitation therapy plus optional delayed ACL reconstruction (n=82), participating in the Conservative vs Operative Methods for Patients with ACL Rupture Evaluation trial. Patients were aged 18 to 65 years (mean 31.3, SD 10.5), 60% male sex (n=100). We evaluated the presence and location of meniscal tears by baseline MRI. We analysed and compared how many patients per randomisation group had a meniscal procedure during follow-up in the ACL injured knee, adjusted for sex, body mass index, age group and orthopaedic surgeon.

Results At baseline, 41% of the entire study population (69/167 patients) had a meniscal tear on MRI. During the 2-year follow-up, 25 patients randomised to early ACL reconstruction (29%, 25/85 patients) had a meniscal procedure, compared with 17 patients randomised to rehabilitation plus optional delayed reconstruction (21%, 17/82 patients) (risk ratio 0.67 with 95% CI 0.40 to 1.12, p=0.12). Of these patients who received early ACL reconstruction (n=82) and patients that received delayed ACL reconstruction (n=41), 5% of the patients had an additional isolated meniscal procedure after ACL reconstruction. In patients who received no ACL reconstruction (n=41), 10% (n=4) had an isolated surgical procedure for a meniscal tear during the 2-year follow-up period.

Conclusion Initial non-surgical treatment of ACL ruptures followed by optional delayed ACL reconstruction does not lead to a higher number of meniscal procedures compared with early ACL reconstruction over a 2-year follow-up period.

Trial registration number NL 2618.

  • Meniscus
  • Anterior Cruciate Ligament

Data availability statement

Data are available on reasonable request. Individual deidentified participant data that underlie the results reported in this paper (text, tables, figures and appendices) and the study protocol will be shared if requested. Data will be available beginning 12 months and ending 5 years after publication of this paper. Data will be available for researchers who provide a methodologically sound scientific proposal, which has been approved by an ethical committee. Proof of the latter should be provided. Analyses should achieve the aims reported in the approved proposal. Proposals for data should be directed to the corresponding author (d.meuffels@erasmusmc.nl).

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Data availability statement

Data are available on reasonable request. Individual deidentified participant data that underlie the results reported in this paper (text, tables, figures and appendices) and the study protocol will be shared if requested. Data will be available beginning 12 months and ending 5 years after publication of this paper. Data will be available for researchers who provide a methodologically sound scientific proposal, which has been approved by an ethical committee. Proof of the latter should be provided. Analyses should achieve the aims reported in the approved proposal. Proposals for data should be directed to the corresponding author (d.meuffels@erasmusmc.nl).

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Footnotes

  • Contributors MR and DEM conceived and designed the study. All authors acquired, analysed or interpreted the data. SJAvdG and MR performed the statistical analysis. SJAvdG, MR and DEM drafted the manuscript. All authors critically revised the manuscript for important intellectual content. MR and DEM are the guarantors.

  • Funding A grant for the study was received from ZonMw, a Dutch organisation for health research and care innovation.

  • Disclaimer The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.