Comparison of immediate versus delayed surgical repair for treatment of acute anterior cruciate ligament injury - a Randomized controlled trial Dr Ashish Sachdeva Assistant Prof HOD PMR ( MBBS DNB PMR ) , Dr Prof. Sanjay HOD ORTHOPAEDICS ( MBBS , MS ORTHO ) GSVM Medical college and Hospital

Registration ID: IJNRD_309208

Published ID: IJNRD2509106

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Dr Ashish Sachdeva

ACL DELAYED CONSERVATIVE

Rupture of the anterior cruciate ligament (ACL) is a common injury, especially in young, physically active individuals. The ACL has an important role in both static and dynamic stabilisation of the knee joint with a primary role limiting anterior translation of the tibia relative to the femur. In more than 70% of the injuries, the rupture occurs during a non-contact mechanism, such as a sudden change of direction or landing with the knee near full extension [4]. Frequently, not only the ACL is ruptured but typically also injuries to the menisci, cartilage, collateral ligaments and subchondral bone are present. The rupture of the ACL and damage to other knee stabilising structures, often results in knee joint instability affecting daily activities and sports leading to poor knee related quality of life. Furthermore, ACL injuries are associated with increased risk of post traumatic knee osteoarthritis (PTOA) [5] and athletes who return to sport have a high risk to sustain a re-injury [6]. The medical community has always been convinced that surgical repair of the ACL was necessary to restore mechanical knee stability so that patients can safely return to sports [7], but also to avoid long term disadvantages such as persistent knee instability, re-injury [6] and PTOA [5, 8]. However, evidence assessing treatment outcomes after ACL reconstruction does not support these beliefs. Ardern et al. [9] found that only 55% of athletes who underwent an ACL reconstruction return to their preinjury sport level. Furthermore, a recent meta-analysis showed that about 50% of the patients who underwent surgical repair of their ACL have cartilage degeneration 20 years after surgery [10] and up to 23% suffer a new ACL injury (ipsilateral or contralateral) within two years after return to sport [11]. Based on these results, one can assume that ACL reconstruction offers no certainty of restoration of normal knee function and protection from long-term disadvantages. Besides, it is uncertain whether ACL reconstruction results in benefits at all compared to conservative treatment. In earlier studies in total, 3 RCTs compared the clinical effectiveness between ACL reconstruction and conservative treatment (= rehabilitation + optional delayed surgery): the KANON trial [1] COMPARE trial [2] and ACL SNNAP [12]). The KANON trial concluded that a strategy of early reconstruction plus rehabilitation did not provide better results at five years than a strategy of initial rehabilitation with optional delayed ACL reconstruction [1, 13].The COMPARE trial found slightly better self-reported outcomes (knee symptoms, self-reported knee function, and perception of the ability to participate in sports) in the immediate ACL reconstruction group compared with the conservative group at two years follow-up. However, none of these findings were considered clinically important. The SNAPP trial investigated chronic ACL ruptures and found that patients with chronic symptomatic ACL deficiency have better clinical outcomes if they undergo surgery [12]. Based on the results of the KANON trial [1] and the COMPARE trial [2] one can conclude that conservative management with optional delayed surgery does not result in inferior clinical outcomes compared to immediate ACL reconstruction on a population level [14]. Though, on the level of the individual patient, large between-subject differences were found. In the KANON trial, 39% of the ACL patients in the conservative treatment group showed persistent knee instability requiring delayed surgery during the two years follow up, this percentage has grown to 51% at the five years follow up [1, 13]. The compare trial reported that 50% of the ACL patients in the conservative group required delayed surgery in the two years follow up [2]. In this group of patients, time to return-to-sport is extended, and longer sick leave times are observed because surgery is delayed compared to patients undergoing immediate ACL reconstruction [15]. Hence, early identification of patients who would benefit from early ACL reconstruction, or on the contrary, from rehabilitation alone, is crucial to reduce resource consumption and decrease irrelevant overtreatment. It is hypothesized that treatment success relies on clinical factors (such as knee function and MRI features [16] ) as well as the quality of rehabilitation [17], and psychological factors such as expectations [18], fear of re-injury [19, 20] and locus of control [21]. This RCT has 2 aims: (1) to compare the clinical effectiveness of both treatment options and as such verify the existing literature, and (2) to assesses which patient-specific factors predict successful outcomes after conservative treatment of ACL injuries.

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Dr Ashish Sachdeva (September-2025). Comparison of immediate versus delayed surgical repair for treatment of acute anterior cruciate ligament injury - a Randomized controlled trial Dr Ashish Sachdeva Assistant Prof HOD PMR ( MBBS DNB PMR ) , Dr Prof. Sanjay HOD ORTHOPAEDICS ( MBBS , MS ORTHO ) GSVM Medical college and Hospital . INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT, 10(9), b68-b82. https://ijnrd.org/papers/IJNRD2509106.pdf

Volume 10 Issue 9, September-2025

Pages : b68-b82

Paper Reg. ID: IJNRD_309208

Published Paper Id: IJNRD2509106

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Country: NEW DELHI, NEW DELHI, India

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