Patient reported outcomes and mechanical knee stability measures at five years and change between two and five years for as treated groups (n=118)
| Outcome | As treated groups | Mean between group differences | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Early ACL reconstruction (n=59) | Delayed ACL reconstruction (n=30) | Rehabilitation alone (n=29) | Early v delayed ACL reconstruction | P value | Early ACL reconstruction v rehabilitation alone | P value | Delayed ACL reconstruction v rehabilitation alone | P value | ||
| Mean (95% CI) follow-up after randomisation (months) | 60 (59 to 61) | 59 (57 to 60) | 58 (55 to 61) | 1 (−1 to 2) | 0.883 | 2 (−1,4) | 0.145 | 1 (−3 to 4) | 0.611 | |
| Patient reported outcomes at 5 years | ||||||||||
| Mean (95% CI) KOOS*: | ||||||||||
| KOOS4† | 80 (75 to 84) | 81 (75 to 88) | 82 (76 to 88) | −1 (−9 to 6) | 0.698 | −3 (−10 to 5) | 0.492 | −1 (−10 to 8) | 0.804 | |
| Pain | 91 (88 to 94) | 91 (86 to 96) | 92 (87 to 96) | 0 (−5 to 5) | 0.968 | −1 (−6 to 4) | 0.697 | −1 (−7 to 5) | 0.771 | |
| Symptoms | 83 (78 to 87) | 85 (79 to 90) | 89 (83 to 95) | −3 (−10 to 5) | 0.466 | −7 (−15 to 0) | 0.054 | −5 (−12 to 3) | 0.221 | |
| Activities of daily living | 95 (93 to 97) | 97 (95 to 99) | 96 (93 to 100) | −2 (−6 to 1) | 0.246 | −1 (−5 to 3) | 0.537 | 1 (−3 to 4) | 0.649 | |
| Sport and recreation | 76 (70 to 81) | 78 (68 to 87) | 81 (73 to 90) | −2 (−13 to 9) | 0.712 | −6 (−16 to 4) | 0.255 | −4 (−16 to 9) | 0.536 | |
| Knee related QOL | 71 (65 to 76) | 72 (63 to 80) | 66 (58 to 75) | −1 (−11 to 9) | 0.822 | 4 (−6 to 14) | 0.401 | 5 (−7 to 17) | 0.388 | |
| Mean (95% CI) SF-36‡: | ||||||||||
| Physical component | 85 (79 to 92) | 83 (78 to 89) | 85 (79 to 92) | 2 (−5 to 9) | 0.616 | 0 (−8 to 7) | 0.967 | −2 (−10 to 7) | 0.652 | |
| Mental component | 87 (83 to 91) | 86 (81 to 91) | 83 (76 to 90) | 1 (−5 to 8) | 0.677 | 4 (−3 to 11) | 0.294 | 3 (−6 to 11) | 0.543 | |
| Median (interquartile range) Tegner activity scale§ | 4 (2 to 7) | 4 (2 to 7) | 4 (2 to 6.5) | 0 (−1 to 1) | 0.734 | 0 (−1 to 1) | 0.959 | 0 (−2 to 1) | 0.949 | |
| No (%) active at pre-injury Tegner activity scale level¶ | 13 (22) | 6 (20) | 6 (21) | 2 (−17 to 18)** | 0.828 | 1 (−18 to 18)** | 0.915 | −1 (−22 to 20)** | 0.924 | |
| Mechanical knee stability at 5 years | ||||||||||
| No (%) normal Lachman test†† | 45 (76) | 18 (60) | 1/28 (4) | 16 (−3 to 36)** | 0.121 | 72 (52 to 82)** | <0.001 | 56 (32 to 71)** | <0.001 | |
| No (%) normal pivot shift test‡‡ | 45 (76) | 18 (60) | 5/28 (18) | 16 (−3 to 36)** | 0.121 | 58 (38 to 72)** | <0.001 | 42 (17 to 60)** | 0.002 | |
| Change in patient reported outcomes (5 minus 2 years) | ||||||||||
| Mean (95% CI) KOOS: | ||||||||||
| KOOS4 | 4 (1 to 8) | 8 (0 to 15) | 3 (−1 to 8) | −3 (−11 to 4) | 0.337 | 1 (−5 to 7) | 0.754 | 4 (−4 to 13) | 0.308 | |
| Pain | 4 (1 to 7) | 5 (0 to 11) | 2 (−1 to 5) | −1 (−7 to −4) | 0.648 | 2 (−2 to 7) | 0.363 | 3 (−3 to 10) | 0.302 | |
| Symptoms | 4 (0 to 8) | 4 (−2 to 11) | 3 (−2 to 9) | −1 (−8 to 6) | 0.856 | 0 (−6 to 7) | 0.900 | 1 (−7 to 9) | 0.789 | |
| Activities of daily living | 2 (−1 to 4) | 3 (0 to 6) | 2 (0 to 4) | −1 (−5 to 3) | 0.725 | 0 (−3 to 4) | 0.869 | 1 (−2 to 4) | 0.571 | |
| Sport and recreation | 5 (−1 to 11) | 11 (1 to 22) | 5 (−1 to 12) | −6 (−17 to 5) | 0.254 | −1 (−10 to 9) | 0.912 | 6 (−7 to 18) | 0.360 | |
| Knee related QOL | 4 (0 to 8) | 10 (0 to 20) | 2 (−5 to 9) | −6 (−17 to 5) | 0.283 | 2 (−6 to 9) | 0.643 | 8 (−4 to 20) | 0.205 | |
| Mean (95% CI) SF-36: | ||||||||||
| Physical component | 4 (−1 to 8) | 9 (4 to 14) | 4 (−2 to 9) | −5 (−13 to 2) | 0.157 | 0 (−8 to 8) | 0.992 | 5 (−2 to 13) | 0.153 | |
| Mental component | −1 (−5 to 3) | 1 (−5 to 8) | 1 (−3 to 3) | −2 (−9 to 5) | 0.607 | −1 (−7 to 5) | 0.707 | 1 (−6 to 8) | 0.838 | |
ACL=anterior cruciate ligament; KOOS=knee injury and osteoarthritis outcome score; QOL=quality of life.
*KOOS ranges from 0 to 100, with higher scores indicating better results.12, 13
†Includes four KOOS subscales: pain, symptoms, function in sports and recreation, and knee related quality of life; scores range from 0 to 100, with higher scores indicating better results.7
‡Scores range from 0 to 100, with higher scores indicating better results.14
§Assesses activity level with specific emphasis on knee; scores range from 1 (least strenuous activity) to 10 (high knee demanding activity on professional sports level).15
¶Patients with score at five years that was same as or higher than pre-injury score.
**95% confidence interval for percentage.
††Assesses anteroposterior laxity of knee at rest in semiflexed position; results range from 0 (normal laxity) to 3 (severely increased laxity); data include knees with normal laxity.
‡‡Assesses rotational stability of knee at rest; results range from 0 (normal stability) to 3 (severely increased instability); data include knees with normal stability.