Voorkomt de vroege reconstructie van de voorste kruisband de ontwikkeling van meniscusbeschadiging? Resultaten van een secundaire analyse van een gerandomiseerde gecontroleerde studi

Voorkomt de vroege reconstructie van de voorste kruisband de ontwikkeling van meniscusbeschadiging? Resultaten van een secundaire analyse van een gerandomiseerde gecontroleerde studi

mei 10, 2020 0 Door admin

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Does early anterior cruciate ligament reconstruction prevent development of meniscal damage? Results from a secondary analysis of a randomised controlled trial

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  1. http://orcid.org/0000-0002-5420-9200Barbara A Snoeker1,
  2. Frank W Roemer2,3,
  3. Aleksandra Turkiewicz1,
  4. http://orcid.org/0000-0002-5424-9448Stefan Lohmander4,
  5. Richard B Frobell4,
  6. Martin Englund1,5

  1. 1 Lund University, Faculty of Medicine, Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden

  2. 2 Radiology, Universitatsklinikum Erlangen, Erlangen, Germany

  3. 3 Radiology, Boston University School of Medicine, Boston, Massachusetts, USA

  4. 4 Lund University, Faculty of Medicine, Clinical Sciences Lund, Orthopaedics, Lund, Sweden

  5. 5 Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA
  1. Correspondence to Dr Barbara A Snoeker, Faculty of Medicine, Clinical Sciences, Lund University, Lund 22185, Sweden; barbara.snoeker{at}med.lu.se

Abstract

Objectives To determine development of new and worsening meniscal damage over 5 years after acute anterior cruciate ligament (ACL) injury comparing rehabilitation plus early ACL reconstruction (‘early-ACLR’) versus rehabilitation with optional delayed ACL reconstruction (‘optional-delayed-ACLR’).

Methods We used knee MRIs from the only randomised controlled trial in the field including 121 young adults. One musculoskeletal radiologist read baseline and 5-year follow-up images using the Anterior Cruciate Ligament Osteoarthritis Score (ACLOAS). We defined development (ie, new and worsening) of meniscal damage both dichotomously and as a sum score representing severity (based on the reclassified ACLOAS meniscus grades). In the full analysis set, we analysed development of meniscal damage (yes/no) with logistic regression and severity with zero-inflated Poisson regression and adjusted for age, sex and baseline meniscal damage.

Results Over 5 years, new or worsening meniscal damage developed in 45% of subjects with early-ACLR and in 53% of subjects with optional-delayed-ACLR. The relative risk for development of meniscal damage on knee level was 1.3 (95% CI 0.9 to 1.9) in optional-delayed-ACLR versus early-ACLR. For medial and lateral meniscal damage, respectively, the relative risks were 2.1 (95% CI 1.1 to 3.9) and 1.0 (95% CI 0.6 to 1.5). The mean severity score was 1.5 higher (more severe damage) on knee level in optional-delayed-ACLR versus early-ACLR (95% CI 1.1 to 1.9) among those with meniscal damage at 5 years. For medial and lateral meniscal damage, respectively, the corresponding scores were 1.7 (95% CI 1.2 to 2.5) and 1.1 (95% CI 0.8 to 1.4).

Conclusion A strategy of early-ACLR may reduce development of medial meniscal damage following acute ACL injury. For the lateral meniscus, ACLR seems neither to be protective nor to increase the risk of damage.

Trial registration number ISRCTN 84752559.

  • ACL
  • knee
  • meniscus
  • randomised controlled trial
  • knee surgery

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