2021 ISAKOS Biennial Congress Paper
Meniscal Procedures are not Increased with Delayed ACL Reconstruction and Rehabilitation: Results from a Randomized Controlled Trial
Sabine van der Graaff, MD NETHERLANDS
Max Reijman, PhD, Benthuizen NETHERLANDS
Eline van Es, MSc, Rotterdam NETHERLANDS
Sita Bierma-Zeinstra, MD, Rotterdam NETHERLANDS
Jan Verhaar, MD, PhD, Prof., Rotterdam NETHERLANDS
Duncan E. Meuffels, MD, PhD, Rotterdam NETHERLANDS
Erasmus University Medical Center, Rotterdam, NETHERLANDS
FDA Status Not Applicable
Summary
We assessed whether non-operative treatment of anterior cruciate ligament ruptures leads to more meniscal procedures compared to early ACL reconstruction. We found that initial non-operative treatment does not lead to more meniscal procedures compared to early ACL reconstruction over a two-year follow-up period.
Abstract
Objective
To assess whether initial non-operative treatment of anterior cruciate ligament (ACL) ruptures leads to more meniscal procedures compared to early ACL reconstruction.
Methods
We compared the number of meniscal procedures of 167 patients with an ACL rupture, who either received early ACL reconstruction (n=85) or rehabilitation therapy plus optional delayed ACL reconstruction (n=82), participating in the COMPARE trial. We evaluated the presence and location of meniscal tears by baseline MRI. Meniscal surgical procedures were described per time period: before ACL reconstruction, during ACL reconstruction and after ACL reconstruction till end of follow-up (two years). When no ACL reconstruction was performed, we described all meniscal procedures during the follow-up period.
Results
At baseline 41% of the entire study population (n=167) had a meniscal tear on MRI. During the two-year follow-up 28 meniscal procedures were performed in 25 patients randomized to early ACL reconstruction (29%, 25/85 patients) and 20 procedures in 17 patients randomized to rehabilitation plus optional delayed reconstruction (21%, 17/82 patients) (between group difference 9% with 95% confidence interval -4% to 22%). In patients who received early ACL reconstruction (n = 82) and patients who received delayed ACL reconstruction (n = 41), 5% of the patients had an additional meniscal procedure after ACL reconstruction. In patients who received no ACL reconstruction (n=41), 10% (n=4) had a surgical procedure for a meniscal tear during the two-year follow-up period.
Conclusion
The results of this study suggest that initial non-surgical treatment of ACL ruptures does not lead to a higher number of meniscal procedures compared to early ACL reconstruction over a two-year follow-up period.