Smallest worthwhile effect of anterior cruciate ligament reconstruction compared with non-surgical management: a benefit-harm trade-off study

Key Points

1. This benefit-harm trade-off study investigated the minimum additional improvements ACL reconstruction would need to provide over rehabilitation alone for athletes to consider it worthwhile.

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BACKGROUND & OBJECTIVE

After an anterior cruciate ligament (ACL) tear, athletes can either undergo reconstructive surgery (followed by rehabilitation) or rehabilitation alone (with the option for surgery later). Traditionally, reconstruction has been the default treatment option. However, randomized controlled trials have shown minimal differences in knee function and return-to-sport rates between treatment options at two years follow-up (1,2).

Few studies have explored athletes’ perspectives on the minimum additional improvement that would make reconstruction worthwhile compared to rehabilitation alone (i.e. the smallest worthwhile effect [3]). This study investigated the smallest effect ACL reconstruction would need to provide over rehabilitation alone for athletes to consider it worthwhile.

ACL Reconstruction has traditionally been the default treatment option; however, trials have shown minimal differences in knee function and return-to-sport rates between treatment options at two years follow-up.

This study can help the clinician provide a framework for shared decision-making where patients can be provided information about the expected benefits, inconveniences, costs, and risks of both treatment options.

METHODS

For this benefit-harm trade-off survey, participants were presented with an information table that compared ACL reconstruction with rehabilitation alone. The table included the nature, inconveniences, costs, and risks of each treatment. They were informed that by two years post-ACL rupture,

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