Abstract
Objectives
Evaluate the natural course of anterior cruciate ligament (ACL)
healing on MRI within 5 years of acute ACL rupture and compare 2-year
and 5-year outcomes based on healing status and treatment
group.
Methods
Secondary analysis of 120 Knee Anterior Cruciate Ligament
Nonsurgical vs Surgical Treatment (KANON) trial participants randomised
to rehabilitation and optional delayed ACL reconstruction (ACLR) or
early ACLR and rehabilitation. ACL continuity on MRI (Anterior Cruciate
Ligament OsteoArthritis Score 0–2) was considered evidence of ACL
healing. Outcomes included Knee Injury and Osteoarthritis Outcome Score
(KOOS), KOOS patient acceptable symptomatic state (PASS) and treatment
failure criteria. Linear mixed models were used to estimate adjusted
mean differences (95% CIs) in patient-reported sport and recreational
function (KOOS-Sport/Rec) and quality of life (KOOS-QOL) at 2 and 5
years, between participants with MRI evidence of ACL healing and those
who had (1) no evidence of ACL healing, (2) delayed ACLR or (3) early
ACLR.
Results
MRI evidence of ACL healing at 2-year follow-up was observed in 16
of 54 (30%, 95% CI 19 to 43%) participants randomised to optional
delayed ACLR. Excluding participants who had delayed ACLR, 16 of 30
(53%, 36–70%) participants managed with rehabilitation-alone displayed
MRI evidence of ACL healing. Two-year outcomes were better in the healed
ACL group (n=16) compared with the non-healed (n=14) (mean difference
(95% CI) KOOS-Sport/Rec: 25.1 (8.6–41.5); KOOS-QOL: 27.5 (13.2–41.8)),
delayed ACLR (n=24) (KOOS-Sport/Rec: 24.9 (10.2–39.6); KOOS-QOL: 18.1
(5.4–30.8)) and early ACLR (n=62) (KOOS-Sport/Rec: 17.4 (4.1–30.7);
KOOS-QOL: 11.4 (0.0–22.9)) groups. Five-year KOOS-QOL was better in the
healed versus non-healed group (25.3 (9.4–41.2)). Of participants with
MRI evidence of ACL healing, 63–94% met the PASS criteria for each KOOS
subscale, compared with 29–61% in the non-healed or reconstructed
groups.
Conclusions
MRI appearance of ACL healing after ACL rupture occurred in one in
three adults randomised to initial rehabilitation and one in two who did
not cross-over to delayed ACLR and was associated with favourable
outcomes. The potential for spontaneous healing of the ACL to facilitate
better clinical outcomes may be greater than previously
considered.
Trial registration number
NCT84752559.
Funder
Crafoord
Foundation
National
Health and Medical Research Council
Pfizer
Ragna
Gorthon Research Foundation (RBF), Swedish National
Centre
RBF
Swedish
Research Council
Tore
Nilsson Research Fund
Subject
Physical Therapy, Sports Therapy and Rehabilitation,Orthopedics and Sports Medicine,General Medicine
Cited by
14 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献