Early surgical reconstruction versus rehabilitation with elective delayed reconstruction for patients with anterior cruciate ligament rupture: COMPARE randomised controlled trial
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(5):36 BMJ . 2021 Mar 9:372:n375.¿Qué significa esto para mi consulta?
Clinicians should recognize that while early ACL reconstruction results in statistically significant but clinically uncertain improvements in knee function at two years, half of the patients randomized to rehabilitation did not require surgery. This suggests that a rehabilitation-first approach is viable for many patients. The main takeaway is that patient selection for early surgery should be individualized. Limitations include potential selection bias and the inability to determine the long-term impact on osteoarthritis development.
Resumen del estudio
One hundred sixty-seven patients with acute ACL rupture were randomized to receive either early ACL reconstruction (n=85) or rehabilitation with the option for delayed ACL reconstruction after three months (n=82). The primary outcome was patients’ perceptions of symptoms, knee function, and ability to participate in sports, assessed using the International Knee Documentation Committee (IKDC) score over a 24-month period. Secondary outcomes included the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, return to pre-injury sporting level, knee instability (giving way), and patient satisfaction. After two years, the early ACL reconstruction group showed a significantly better IKDC score, but the clinical relevance of this difference is uncertain. At three months, the rehabilitation group had a significantly better IKDC score, but by nine months, the advantage shifted toward the early ACL reconstruction group. Half (50%) of the rehabilitation group eventually required delayed reconstruction. Overall, early ACL reconstruction led to small but statistically significant improvements in knee function at two years, though non-operative treatment was successful for half of the patients.
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