2015 ISAKOS Biennial Congress ePoster #1276

Differences in Early Results Between Sub-Acute And Delayed ACL Reconstruction. A Randomized Controlled Trial

Henrik Illerström, MD, Stockholm SWEDEN
Björn Barenius, MD, PhD, ass. Prof., Stockholm SWEDEN
Karl Eriksson, MD, PhD, Prof., Stockholm SWEDEN
Karolinska Institutet, Stockholm, SWEDEN

FDA Status Cleared

Summary: Is it with modern technique, safe to reconstruct the ACL in the sub-acute phase, and can it be beneficial in terms of decreased loss of muscle function.

Abstract:

Objectives:
Historically acute ACL reconstruction has been avoided due to reports of early rehabilitation problems with stiffness. Are these reports still valid today with modern arthroscopic techniques?
The aim of this RCT was to assess the impact of the time between injury and reconstruction on the range of motion (ROM) after ACL surgery.
Our hypothesis was that with modern technique it is safe and can be beneficial to reconstruct the ACL in the sub-acute phase. Power analysis indicated a need of 64 patients to find a 5 degree difference in ROM at 3 months.

Methods

70 patients with a high recreational activity level, Tegner level of 6 or more (except for one miss-included with 5) who presented with an acute ACL injury were randomized to a sub-acute reconstruction within 8 days from the injury or delayed reconstruction after normalized ROM between 6-10 weeks. Four surgeons performed the ACL reconstructions with quadrupled semitendinosus tendon grafts. Fixation was with Endobutton in femur and metallic interference screw in tibia. The rehabilitation training was performed at the same physiotherapy centre for all patients. For the first 3 months the patients were followed weekly by SMS, with the question: How are your knee working? ROM was assessed after 3 months. The follow up at 6 months included a Biodex strength test, Lachman, Rolimeter, pivot shift, one leg hop, IKDC, KOOS, Lysholm and Tegner activity level.

Results

Seventy percent of the patients were males, mean age at the time of inclusion was 27 years (18 -41) and the pre-injury Tegner level was median 9 (5-10), there were no differences between the groups. One patient in the delayed group dropped out before surgery. 64 patients (91%) were assessed at 3 months.
There were no differences between the groups in ROM at 3 months, and no differences in IKDC, activity level or laxity at 6 months. Five patients had a combined extension and flexion deficit of more than 15 degrees, two from the sub-acute group and three delayed. In the sub-acute group 84% had an objective IKDC grade A or B compared with 71% in the delayed group. The one leg hop index above 90% was found in 21% in the delayed group and in 47% in the acute group (p=0.009)

Conclusions

Acute reconstruction of the ACL can be performed without increased risk of stiffness and a potential benefit might be decreased loss of muscle function.