Editorials

Treating ACL injuries in young moderately active adults

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f963 (Published 13 February 2013) Cite this as: BMJ 2013;346:f963
  1. Bruce A Levy, associate professor,
  2. Aaron J Krych, assistant professor ,
  3. Diane L Dahm, associate professor,
  4. Michael J Stuart, professor
  1. 1Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN 55905, USA
  1. B A Levy

Individual patient factors should guide the decision on whether to surgically reconstruct

Many who delay surgery end up having reconstruction anyway

PAUL RAPSON/ SPL

Currently, the clinical indication for anterior cruciate ligament (ACL) reconstruction takes into account both patient related and knee related factors. In an effort to better identify these factors, Frobell and colleagues performed a randomized clinical trial comparing two treatment strategies for young moderately active patients with a torn ACL. Patients were randomized to “acute” ACL reconstruction (within 10 weeks) or “optional delayed” ACL reconstruction (rehabilitation with the option for delayed surgery).1 In 2010, the authors published two year outcomes that reported no difference between the two treatment arms in the primary outcome (knee injury and osteoarthritis outcome score; KOOS) or secondary outcomes of SF-36 and Tegner activity scale (TAS). However, supplementary data provided in an appendix reported 29 subsequent meniscus tears in the “optional delayed” group, and by two years almost 40% of the patients in this group had already crossed over to ACL reconstruction surgery.

In the linked study (doi:10.1136/bmj.f232), Frobell and colleagues report the five year outcomes for the trial.2 Similar to …

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