Table 1

Study characteristics

StudyYearStudy typeInclusion criteriaExclusion criteriaPatients (INT/CON) at baselineMean age (SD) (INT/CON)Sex F (INT/CON)BMI kg/m2
mean (SD) INT/CON)
Participating in sports_while injured n (%)INT typeCON typePrimary end pointOther follow-upsPrimary outcome(s)Secondary outcomes
Frobell et al54 552010, 2013RCTAge: 18–35 years.
Recent rotational knee trauma to previously uninjured knee within 4 preceding weeks, ACL insufficiency by clinical exam (positive pivot shift and/or positive Lachmann test), 5–9 points on TAS score before injury, complete ACL tear on MRI in isoloation or combined with meniscus tear, normal radiographic knee joint status or small-avulsed fragment
(second fracture)
b.JSN grade 1 or osteophytes grade 1
Earlier major knee injury to the index knee, previous knee surgery (other than diagnostic arthroscopy) to index knee, associated PCL injury or MCL injury grade III in index knee, concomitant severe injury to contra- lateral knee at the time of assessment, Injury to the lateral/posterolateral ligament complex with significantly increased
Laxity, total collateral ligament rupture, full-thickness cartilage lesion on MRI, unstable longitudinal meniscus tear that requires (a) bi-compartmental extensive meniscus resections, (b) a cartilage injury with full thickness loss down to bone (c) total rupture of MCL/LCL on MRI, pregnancy, claustrophobia, history of DVT, general systemic disease, systemic medication/abuse of steroids
62/5926.3 (5.1)/25.5 (4.7)12/2024.4 (3.2)/23.8 (2.6)62(100)/ 57(97)Progressive, supervised rehabilitation with goals for ROM, muscle function, and functional performance (four phases)
+ early ACL reconstruction (within 10 w after injury) by one of four senior knee surgeons, choice of procedure depended on surgeons preference(patella -tendon autograft, hamstring autograft), meniscal surgery performed as needed.
Progressive, supervised rehabilitation with goals for ROM, muscle function, and functional performance (four phases)
Elective ACL reconstruction by the same surgeons if certain criteria were met (self-reported symptomatic instability caused by
ACL insufficiency and positive pivot shift test)
24 m3 m, 6 m, 12 m, 24 m, 60 mKOOS (without ADL scale)SF-36, TAS, knee stability (Lachman test, pivot shift test;
KT1000 arthrometry), adverse events, meniscal surgery, and radiographic osteoarthritis, KOOS5
(with ADL scale), Subgroup with KOOS-ADL Score<44
Reijman et al532021RCTAge 18–65 years, acute (within 2 m after initial trauma), complete primary ACL rupture (confirmed by MRI and clinical examination), willingness of patient to be randomised,History of injury to ACL of the contralateral knee, presence of another disorder affecting the activity of the lower limb, dislocated bucket handle lesion of the meniscus with extension deficit, insufficient command of the Dutch language,85/8231.2 (10.3)/ 31.4 (10.7)36/3124.3 (3.7)/25 (4.1)76 (89.4)/ 71 (86.6)Early ACL reconstruction (within 6 w after randomisation), surgeons chose their preferred technique and graft and decided if more intraarticular surgery was necessary, all surgeons had a minimum of 10 years experience,
+ physical therapy rehabilitation until good functional control was achieved.
Referral to supervised rehabilitation by physical therapist for a minimum of 3 m, physical therapy was done after Dutch ACL guidelines, after a minimum of 3 m patients had the option for reconstruction of ACL if instability persisted or activity level was not reached.24 m3 m, 6 m, 9 m, 12 mIKDCKOOS, TAS, Satisfaction (five point likert scale), serious adverse events
Tsoukas et al522016RCTIsolated ACL injuries, BMI<30, no previous major injury or surgery to the knee, patients completed the final follow-up successfully.Combined ACL injuries, BMI>30, prior knee surgery17/1529 (5.1)/ 32.3 (4.7)17 (0)/15 (0)NR/NRNR/NRACL reconstruction, median time interval between the initial injury and beginning of treatment 6 w (range 4–8, ACL reconstruction via hamstring autograft performed by one surgeon,
+rehabilitation as CON group
Rehabilitation, median time interval between the initial injury and beginning of treatment 6 w (range 4–8), passive knee motions directly after surgery, partial weight bearing for the first 6 w, full knee extension brace, stationary bike, proprioception exercises, short arc quadriceps sets and hamstring curls for 6 w, third postoperative month, jogging, swimming (in straight line), bicycle were allowed, at 6 m pivot sports (eg, ski, tennis, squash) were started, contact sports were permitted after eight m.Median 120 m (range 120–132 m)Median 120 m (range 120–132 m)unclearIKDC, knee stability (KT1000 arthrometry, 67N, 89N, 134N), knee osteoarthritis, adverse events
  • ACL, anterior cruciate ligament; BMI, body mass index; CON, rehabilitation (with elective delayed reconstruction); DVT, deep vein thrombosis; IKDC, International knee documentation committee score; INT, (early) surgical reconstruction; JSN, joint space narrowing; KOOS, Knee Injury and Osteoarthritis Outcome Score; m, month; NR, not reported; ROM, Range of Motion; SF-36, Medical Outcomes Study 36-Item Short-Form Health Survey; TAS, Tegner Activity Scale; w, week; y, year.