ACLR or Non-op Management?
10 years on from the game-changing research from Frobell and colleagues who showed that non-operative management of ACL injuries can be just as successful as early or delayed ACLR, not much unfortunately has changed with ACLR rates around the world increasing instead of decreasing.
The COMPARE trial looked to replicate the work of Frobell and colleagues (KANON trial) by randomising 167 ACL injured patients into either an early ACLR group (85 patients) or a delayed ACLR group (82 patients who conducted a minimum 3 months of supervised rehab) and followed these patients for 2 years.
The COMPARE trial found that the early ACLR group had a significantly better primary outcome measure (IKDC) than the rehab + delayed ACLR group at 9 month, 1 year and 2 year follow-up time points. However, the authors do report that despite being a statistically significant difference between the 2 groups, the minimal clinical difference threshold for the IKDC (minimum 11 points) was not met at the 2 year follow-up mark.
Furthermore, 50% of the delayed ACLR group persisted with rehab alone for 2 years, and when you look at this group a bit deeper the IKDC scores at 1 year and 2 year were not significantly different between the rehab-alone group and early ACLR group.
So what does this all mean for us as clinicians?
It shows that ongoing non-operative management is certainly a strong choice for some ACL injured patients, and that we should be having this discussion with our patients.
The problem is we probably don't quite know yet who are the ones that will have a successful outcome with rehab alone or an ACLR.
Either way, it's important that we give our patients the best chance of successful outcome whichever treatment choice they choose and we set them up for success with a great rehab plan early after their injury.
Read this paper and tell us what you think by clicking on the link here
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