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Anterior cruciate ligament (ACL) tears are among the most common and costly injuries. Both surgery and rehabilitation options are available to the patient. There is a longstanding difference of opinion as to which is the better strategy for non-acute ACL injuries. This study aimed to compare patient outcome and cost effectiveness for both surgery and rehabilitation.

The study recruited 316 patients with non-acute ACL injuries and persistent instability. This cohort was randomized onto either immediate surgery or rehabilitation. Several outcomes were assessed. Primarily the Knee Injury and Osteoarthritis Outcome Score was compared, but other factors that were compared included quality of life measures, the Tegner activity score (measures activity ranging from zero – disability due to knee injury; to 10 – elite level sport stability), resource use, complications, and patient satisfaction. All patients were followed up at 18 months. The study results determined that both groups showed improvement, though, patients who received immediate surgery had significantly better knee function, pain, patient satisfaction, and Tegner activity scores compared to the rehabilitation group. Cost effectiveness was 72% more likely in patients having had surgery compared to those who had rehabilitation.

For further information on this study, see

OrthoEvidence. Rehabilitation vs. Surgical Reconstruction for Non-acute Anterior Cruciate Ligament Injury. ACE Report. 2022;285(1):1.