DELAYING ACL RECONSTRUCTION AND TREATING WITH EXERCISE THERAPY ALONE MAY ALTER PROGNOSTIC FACTORS FOR 5-YEAR OUTCOME: AN EXPLORATORY ANALYSIS OF THE KANON TRIAL

Review written by Christina Le info

BACKGROUND & OBJECTIVE

Evidence-based recommendations to guide clinicians and patients toward operative or non-operative management of acute anterior cruciate ligament (ACL) ruptures have yet to be established. With various studies reporting poor long-term outcomes following ACL reconstruction, determining the optimal treatment pathway for individuals with an ACL rupture can help minimize negative health consequences.

The objectives of this exploratory analysis were to (1) identify prognostic factors for five-year self-reported outcomes in ACL injured individuals and (2) compare prognostic factors between three treatment groups (early reconstruction plus exercise therapy, exercise therapy plus delayed reconstruction, and exercise therapy alone).

METHODS

This study was a secondary, exploratory analysis of the five-year outcomes of the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) Study. The initial KANON study was a randomized controlled trial that included active adults aged 18-35 years who had an acute ACL rupture. Individuals were enrolled if they had an acute injury (within four weeks), had a complete rupture confirmed by clinical examination, and reported between 5-9 on the Tegner Activity Scale (TAS).

Participants were randomized into two groups in the initial KANON trial: early ACL reconstruction plus exercise therapy or exercise therapy with delayed ACL reconstruction if needed. The delayed reconstruction group was further subdivided into those who inevitably underwent surgery and those who pursued exercise therapy alone.

Prognostic factors included injury-related factors at baseline (e.g. cartilage or meniscus damage), treatment-related factors (e.g. subsequent ACL rupture or non-ACL surgeries), and patient-reported factors at baseline (e.g. Short Form-36 (SF-36) and Knee Injury and Osteoarthritis Outcome Score (KOOS)). The five-year outcome was the KOOS - specifically, the pain, symptoms, sport and recreation function, and QOL subscales. The associations between each prognostic factor and KOOS subscale score were assessed.

RESULTS

118 participants with a mean age of 26 years were included at the five-year mark. Participant breakdown by treatment group included 59 in the early ACLR group, 30 in the delayed ACLR group, and 29 in the exercise therapy alone

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