Long-term functional outcomes were the same.

In a Swedish trial in which conservative management was compared with early surgical repair of isolated anterior cruciate ligament (ACL) tears, early outcomes were similar (NEJM JW Gen Med Sep 1 2010 and N Engl J Med 2010; 363: 331-342; NEJM JW Gen Med Mar 1 2013 and BMJ 2013; 346: f232). The investigators now report 11-year functional outcomes and risk for developing osteoarthritis in both groups. Originally, 121 young adults (mean age, 26 years; mostly men) who were actively involved in sports were randomised to early surgical repair or to intense exercise rehabilitation with the option for delayed surgical repair. Slightly more than half of patients who were randomised to conservative management eventually chose surgical repair.

Anatomical stability assessed by examination was more common in the early-repair group, but several patient-oriented functional outcomes (i.e. pain, symptoms, knee-related quality of life, sports participation) were not different between the early-repair group and the exercise group (with or without delayed repair). More-prevalent and more-severe radiographical osteoarthritis changes were noted in the early-repair group, but these differences were not clinically significant.

Comment: These results should help primary care clinicians guide young active patients about options for isolated ACL tears. The common belief that conservative management or delayed repair imparts higher risk for eventual osteoarthritis appears to be disproven by these longer-term results. One key factor in this study is that the patients had minor meniscal injuries at worst, and no collateral ligament tears, so the results might not apply to patients with the common triad of ACL tear, medial collateral ligament tear and severe meniscal injury (nor to more-elite athletes).

Thomas L. Schwenk, MD, Professor Emeritus, Family and Community Medicine, University of Nevada School of Medicine, Reno, USA.

Lohmander LS, et al. Treatment for acute anterior cruciate ligament tear in young active adults. NEJM Evid 2023 Jun 26; e-pub (https://doi.org/10.1056/ evidoa2200287).

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.