Clinical, Functional, and Physical Activity Outcomes 5 Years Following the Treatment Algorithm of the Delaware-Oslo...

Area of Science:

• Orthopedic surgery
• Sports medicine
• Rehabilitation science

Background:

• Anterior cruciate ligament (ACL) injuries require evaluation of treatment options, including reconstruction (ACLR) or non-operative management.
• High-quality studies comparing outcomes after different ACL injury treatment pathways are essential for clinical decision-making.
• Patient-specific factors and activity levels influence treatment choices for ACL injuries.

Purpose of the Study:

• To compare 5-year clinical, functional, and physical activity outcomes following a structured decision-making algorithm for anterior cruciate ligament (ACL) injuries.
• To evaluate outcomes for patients choosing early ACL reconstruction (ACLR), delayed ACLR, or progressive rehabilitation alone.

Main Methods:

• A prospective cohort study included 276 active patients with unilateral ACL injuries and no major concomitant injuries.
• Patients selected their treatment (early ACLR, delayed ACLR, or rehabilitation alone) via shared decision-making.
• Outcomes assessed at 5 years included subjective knee scores (IKDC-SKF, KOOS), activity rating (Marx), sports participation, muscle strength, hop performance, and re-injury rates.

Main Results:

• At 5 years, 64% underwent early ACLR, 11% delayed ACLR, and 25% rehabilitation alone, with choices influenced by age and injury characteristics.
• No significant differences were observed in clinical, functional, or physical activity outcomes among the three treatment groups.
• High rates of sports participation (95-100%) and acceptable symptom states (65-88% IKDC-SKF/KOOS scores) were reported across all groups.

Conclusions:

• Patients with ACL injuries active in pivoting sports, without significant concomitant injuries, achieved good 5-year knee function and high sport participation.
• Approximately 75% of patients opted for ACL reconstruction within 5 years, either early or delayed.
• Early ACLR, delayed ACLR, and progressive rehabilitation alone yielded comparable 5-year outcomes for this patient cohort.