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Clinical, Functional, and Physical Activity Outcomes 5 Years Following the Treatment Algorithm of the Delaware-Oslo ACL Cohort Study.

Authors :
Pedersen M
Grindem H
Johnson JL
Engebretsen L
Axe MJ
Snyder-Mackler L
Risberg MA
Source :
The Journal of bone and joint surgery. American volume [J Bone Joint Surg Am] 2021 Aug 18; Vol. 103 (16), pp. 1473-1481.
Publication Year :
2021

Abstract

Background: Anterior cruciate ligament (ACL) injuries can be treated with or without ACL reconstruction (ACLR), and more high-quality studies evaluating outcomes after the different treatment courses are needed. The purpose of the present study was to describe and compare 5-year clinical, functional, and physical activity outcomes for patients who followed our decision-making and treatment algorithm and chose (1) early ACLR with preoperative and postoperative rehabilitation, (2) delayed ACLR with preoperative and postoperative rehabilitation, or (3) progressive rehabilitation alone. Early ACLR was defined as that performed ≤6 months after the preoperative rehabilitation program, and late ACLR was defined as that performed >6 months after the preoperative rehabilitation program.<br />Methods: We included 276 patients from a prospective cohort study. The patients had been active in jumping, pivoting, and cutting sports before the injury and sustained a unilateral ACL injury without substantial concomitant knee injuries. The patients chose their treatment through a shared decision-making process. At 5 years, we assessed the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale, sports participation, quadriceps muscle strength, single-legged hop performance, and new ipsilateral and contralateral knee injuries.<br />Results: The 5-year follow-up rate was 80%. At 5 years, 64% of the patients had undergone early ACLR, 11% had undergone delayed ACLR, and 25% had had progressive rehabilitation alone. Understandably, the choices that participants made differed by age, concomitant injuries, symptoms, and predominantly level-I versus level-II preinjury activity level. There were no significant differences in any clinical, functional, or physical activity outcomes among the treatment groups. Across treatment groups, 95% to 100% of patients were still active in some kind of sports and 65% to 88% had IKDC-SKF and KOOS scores above the threshold for a patient acceptable symptom state.<br />Conclusions: Patients with ACL injury who were active in jumping, pivoting, and cutting sports prior to injury; who had no substantial concomitant knee injuries; and who followed our decision-making and treatment algorithm had good 5-year knee function and high sport participation rates. Three of 4 patients had undergone ACLR within 5 years. There were no significant differences in any outcomes among patients treated with early ACLR, delayed ACLR, or progressive rehabilitation alone.<br />Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.<br />Competing Interests: Disclosure: The Delaware-Oslo ACL Cohort study is funded by the National Institutes of Health, grant R37HD37985. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G500).<br /> (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)

Details

Language :
English
ISSN :
1535-1386
Volume :
103
Issue :
16
Database :
MEDLINE
Journal :
The Journal of bone and joint surgery. American volume
Publication Type :
Academic Journal
Accession number :
33999877
Full Text :
https://doi.org/10.2106/JBJS.20.01731