A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears
A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears
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DOI：
10.1056/nejmoa0907797
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发表时间：
2010-07-22
影响因子：
158.5
通讯作者：
Lohmander, L. Stefan
中科院分区：
文献类型：
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作者：
Frobell, Richard B.;Roos, Ewa M.;Lohmander, L. Stefan
最佳的管理撕裂前交叉韧带（ACL）的膝关节是unknown. METHODS我们进行了一项随机对照试验，涉及121名年轻，活跃的成年人急性ACL损伤，我们比较了两种策略：结构化康复加上早期ACL重建和结构化康复，如果需要的话，选择以后ACL重建。主要结局是膝关节损伤和骨关节炎结局评分（KOOS）的4个分量表-疼痛、症状、运动和娱乐功能以及膝关节相关生活质量（KOOS 4;评分范围，0 [最差]至100 [最佳]）的平均评分从基线至2年的变化。次要结果包括所有5个KOOS分量表的结果、医疗结果研究36项简表健康调查和Tegner活动量表评分。在62名被分配接受康复加早期ACL重建的受试者中，1名未接受手术。在59名被分配接受康复加可选延迟ACL重建的患者中，23名接受延迟ACL重建;其他36名仅接受康复。从基线到2年，平均KOOS 4评分的绝对变化为39.2分，对于那些被分配到康复加早期ACL重建的患者，为39.4分，对于那些被分配到康复加可选延迟重建的患者（绝对组间差异，0.2分; 95%置信区间，-6.5至6.8;调整基线评分后P=0.96）。在次要结局方面，两个治疗组之间无显著差异。不良事件在两组中都很常见。结果是相似的数据进行分析时，根据治疗实际received.CONCLUSIONSIn年轻，活跃的成人急性ACL撕裂，康复加早期ACL重建的策略是不是上级的策略，康复加可选延迟ACL重建。后一种策略大大减少了手术重建的频率。（由瑞典研究理事会和隆德大学医学院等资助;当前对照试验编号，ISRCTN 84752559。）
BACKGROUNDThe optimal management of a torn anterior cruciate ligament (ACL) of the knee is unknown.METHODSWe conducted a randomized, controlled trial involving 121 young, active adults with acute ACL injury in which we compared two strategies: structured rehabilitation plus early ACL reconstruction and structured rehabilitation with the option of later ACL reconstruction if needed. The primary outcome was the change from baseline to 2 years in the average score on four subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS) - pain, symptoms, function in sports and recreation, and knee-related quality of life (KOOS4; range of scores, 0 [worst] to 100 [best]). Secondary outcomes included results on all five KOOS subscales, the Medical Outcomes Study 36-Item Short-Form Health Survey, and the score on the Tegner Activity Scale.RESULTSOf 62 subjects assigned to rehabilitation plus early ACL reconstruction, 1 did not undergo surgery. Of 59 assigned to rehabilitation plus optional delayed ACL reconstruction, 23 underwent delayed ACL reconstruction; the other 36 underwent rehabilitation alone. The absolute change in the mean KOOS4 score from baseline to 2 years was 39.2 points for those assigned to rehabilitation plus early ACL reconstruction and 39.4 for those assigned to rehabilitation plus optional delayed reconstruction (absolute between-group difference, 0.2 points; 95% confidence interval, -6.5 to 6.8; P=0.96 after adjustment for the baseline score). There were no significant differences between the two treatment groups with respect to secondary outcomes. Adverse events were common in both groups. The results were similar when the data were analyzed according to the treatment actually received.CONCLUSIONSIn young, active adults with acute ACL tears, a strategy of rehabilitation plus early ACL reconstruction was not superior to a strategy of rehabilitation plus optional delayed ACL reconstruction. The latter strategy substantially reduced the frequency of surgical reconstructions. (Funded by the Swedish Research Council and the Medical Faculty of Lund University and others; Current Controlled Trials number, ISRCTN84752559.)