@article{filbay_evidence_2022,
	title = {Evidence of {ACL} healing on {MRI} following {ACL} rupture treated with rehabilitation alone may be associated with better patient-reported outcomes: a secondary analysis from the {KANON} trial},
	volume = {57},
	copyright = {© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.},
	issn = {0306-3674, 1473-0480},
	shorttitle = {Evidence of {ACL} healing on {MRI} following {ACL} rupture treated with rehabilitation alone may be associated with better patient-reported outcomes},
	url = {https://bjsm.bmj.com/content/early/2022/11/03/bjsports-2022-105473},
	doi = {10.1136/bjsports-2022-105473},
	abstract = {Objectives Evaluate the natural course of anterior cruciate ligament (ACL) healing on MRI within 5 years of acute ACL rupture and compare 2-year and 5-year outcomes based on healing status and treatment group.
Methods Secondary analysis of 120 Knee Anterior Cruciate Ligament Nonsurgical vs Surgical Treatment (KANON) trial participants randomised to rehabilitation and optional delayed ACL reconstruction (ACLR) or early ACLR and rehabilitation. ACL continuity on MRI (Anterior Cruciate Ligament OsteoArthritis Score 0–2) was considered evidence of ACL healing. Outcomes included Knee Injury and Osteoarthritis Outcome Score (KOOS), KOOS patient acceptable symptomatic state (PASS) and treatment failure criteria. Linear mixed models were used to estimate adjusted mean differences (95\% CIs) in patient-reported sport and recreational function (KOOS-Sport/Rec) and quality of life (KOOS-QOL) at 2 and 5 years, between participants with MRI evidence of ACL healing and those who had (1) no evidence of ACL healing, (2) delayed ACLR or (3) early ACLR.
Results MRI evidence of ACL healing at 2-year follow-up was observed in 16 of 54 (30\%, 95\% CI 19 to 43\%) participants randomised to optional delayed ACLR. Excluding participants who had delayed ACLR, 16 of 30 (53\%, 36–70\%) participants managed with rehabilitation-alone displayed MRI evidence of ACL healing. Two-year outcomes were better in the healed ACL group (n=16) compared with the non-healed (n=14) (mean difference (95\% CI) KOOS-Sport/Rec: 25.1 (8.6–41.5); KOOS-QOL: 27.5 (13.2–41.8)), delayed ACLR (n=24) (KOOS-Sport/Rec: 24.9 (10.2–39.6); KOOS-QOL: 18.1 (5.4–30.8)) and early ACLR (n=62) (KOOS-Sport/Rec: 17.4 (4.1–30.7); KOOS-QOL: 11.4 (0.0–22.9)) groups. Five-year KOOS-QOL was better in the healed versus non-healed group (25.3 (9.4–41.2)). Of participants with MRI evidence of ACL healing, 63–94\% met the PASS criteria for each KOOS subscale, compared with 29–61\% in the non-healed or reconstructed groups.
Conclusions MRI appearance of ACL healing after ACL rupture occurred in one in three adults randomised to initial rehabilitation and one in two who did not cross-over to delayed ACLR and was associated with favourable outcomes. The potential for spontaneous healing of the ACL to facilitate better clinical outcomes may be greater than previously considered.
Trial registration number ISRCTN84752559.},
	language = {en},
	number = {2},
	urldate = {2022-11-07},
	journal = {British Journal of Sports Medicine},
	author = {Filbay, Stephanie Rose and Roemer, Frank W. and Lohmander, L. Stefan and Turkiewicz, Aleksandra and Roos, Ewa M. and Frobell, Richard and Englund, Martin},
	month = nov,
	year = {2022},
	pmid = {36328403},
	note = {Number: 2
Publisher: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine
Section: Original research},
	keywords = {Magnetic Resonance Imaging, anterior cruciate ligament, osteoarthritis, quality of life, rehabilitation},
	pages = {91--98},
}

{"_id":"ghFySY6t5y8ePRGBX","bibbaseid":"filbay-roemer-lohmander-turkiewicz-roos-frobell-englund-evidenceofaclhealingonmrifollowingaclrupturetreatedwithrehabilitationalonemaybeassociatedwithbetterpatientreportedoutcomesasecondaryanalysisfromthekanontrial-2022","author_short":["Filbay, S. R.","Roemer, F. W.","Lohmander, L. S.","Turkiewicz, A.","Roos, E. M.","Frobell, R.","Englund, M."],"bibdata":{"bibtype":"article","type":"article","title":"Evidence of ACL healing on MRI following ACL rupture treated with rehabilitation alone may be associated with better patient-reported outcomes: a secondary analysis from the KANON trial","volume":"57","copyright":"© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.","issn":"0306-3674, 1473-0480","shorttitle":"Evidence of ACL healing on MRI following ACL rupture treated with rehabilitation alone may be associated with better patient-reported outcomes","url":"https://bjsm.bmj.com/content/early/2022/11/03/bjsports-2022-105473","doi":"10.1136/bjsports-2022-105473","abstract":"Objectives Evaluate the natural course of anterior cruciate ligament (ACL) healing on MRI within 5 years of acute ACL rupture and compare 2-year and 5-year outcomes based on healing status and treatment group. Methods Secondary analysis of 120 Knee Anterior Cruciate Ligament Nonsurgical vs Surgical Treatment (KANON) trial participants randomised to rehabilitation and optional delayed ACL reconstruction (ACLR) or early ACLR and rehabilitation. ACL continuity on MRI (Anterior Cruciate Ligament OsteoArthritis Score 0–2) was considered evidence of ACL healing. Outcomes included Knee Injury and Osteoarthritis Outcome Score (KOOS), KOOS patient acceptable symptomatic state (PASS) and treatment failure criteria. Linear mixed models were used to estimate adjusted mean differences (95% CIs) in patient-reported sport and recreational function (KOOS-Sport/Rec) and quality of life (KOOS-QOL) at 2 and 5 years, between participants with MRI evidence of ACL healing and those who had (1) no evidence of ACL healing, (2) delayed ACLR or (3) early ACLR. Results MRI evidence of ACL healing at 2-year follow-up was observed in 16 of 54 (30%, 95% CI 19 to 43%) participants randomised to optional delayed ACLR. Excluding participants who had delayed ACLR, 16 of 30 (53%, 36–70%) participants managed with rehabilitation-alone displayed MRI evidence of ACL healing. Two-year outcomes were better in the healed ACL group (n=16) compared with the non-healed (n=14) (mean difference (95% CI) KOOS-Sport/Rec: 25.1 (8.6–41.5); KOOS-QOL: 27.5 (13.2–41.8)), delayed ACLR (n=24) (KOOS-Sport/Rec: 24.9 (10.2–39.6); KOOS-QOL: 18.1 (5.4–30.8)) and early ACLR (n=62) (KOOS-Sport/Rec: 17.4 (4.1–30.7); KOOS-QOL: 11.4 (0.0–22.9)) groups. Five-year KOOS-QOL was better in the healed versus non-healed group (25.3 (9.4–41.2)). Of participants with MRI evidence of ACL healing, 63–94% met the PASS criteria for each KOOS subscale, compared with 29–61% in the non-healed or reconstructed groups. Conclusions MRI appearance of ACL healing after ACL rupture occurred in one in three adults randomised to initial rehabilitation and one in two who did not cross-over to delayed ACLR and was associated with favourable outcomes. The potential for spontaneous healing of the ACL to facilitate better clinical outcomes may be greater than previously considered. Trial registration number ISRCTN84752559.","language":"en","number":"2","urldate":"2022-11-07","journal":"British Journal of Sports Medicine","author":[{"propositions":[],"lastnames":["Filbay"],"firstnames":["Stephanie","Rose"],"suffixes":[]},{"propositions":[],"lastnames":["Roemer"],"firstnames":["Frank","W."],"suffixes":[]},{"propositions":[],"lastnames":["Lohmander"],"firstnames":["L.","Stefan"],"suffixes":[]},{"propositions":[],"lastnames":["Turkiewicz"],"firstnames":["Aleksandra"],"suffixes":[]},{"propositions":[],"lastnames":["Roos"],"firstnames":["Ewa","M."],"suffixes":[]},{"propositions":[],"lastnames":["Frobell"],"firstnames":["Richard"],"suffixes":[]},{"propositions":[],"lastnames":["Englund"],"firstnames":["Martin"],"suffixes":[]}],"month":"November","year":"2022","pmid":"36328403","note":"Number: 2 Publisher: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine Section: Original research","keywords":"Magnetic Resonance Imaging, anterior cruciate ligament, osteoarthritis, quality of life, rehabilitation","pages":"91–98","bibtex":"@article{filbay_evidence_2022,\n\ttitle = {Evidence of {ACL} healing on {MRI} following {ACL} rupture treated with rehabilitation alone may be associated with better patient-reported outcomes: a secondary analysis from the {KANON} trial},\n\tvolume = {57},\n\tcopyright = {© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.},\n\tissn = {0306-3674, 1473-0480},\n\tshorttitle = {Evidence of {ACL} healing on {MRI} following {ACL} rupture treated with rehabilitation alone may be associated with better patient-reported outcomes},\n\turl = {https://bjsm.bmj.com/content/early/2022/11/03/bjsports-2022-105473},\n\tdoi = {10.1136/bjsports-2022-105473},\n\tabstract = {Objectives Evaluate the natural course of anterior cruciate ligament (ACL) healing on MRI within 5 years of acute ACL rupture and compare 2-year and 5-year outcomes based on healing status and treatment group.\nMethods Secondary analysis of 120 Knee Anterior Cruciate Ligament Nonsurgical vs Surgical Treatment (KANON) trial participants randomised to rehabilitation and optional delayed ACL reconstruction (ACLR) or early ACLR and rehabilitation. ACL continuity on MRI (Anterior Cruciate Ligament OsteoArthritis Score 0–2) was considered evidence of ACL healing. Outcomes included Knee Injury and Osteoarthritis Outcome Score (KOOS), KOOS patient acceptable symptomatic state (PASS) and treatment failure criteria. Linear mixed models were used to estimate adjusted mean differences (95\\% CIs) in patient-reported sport and recreational function (KOOS-Sport/Rec) and quality of life (KOOS-QOL) at 2 and 5 years, between participants with MRI evidence of ACL healing and those who had (1) no evidence of ACL healing, (2) delayed ACLR or (3) early ACLR.\nResults MRI evidence of ACL healing at 2-year follow-up was observed in 16 of 54 (30\\%, 95\\% CI 19 to 43\\%) participants randomised to optional delayed ACLR. Excluding participants who had delayed ACLR, 16 of 30 (53\\%, 36–70\\%) participants managed with rehabilitation-alone displayed MRI evidence of ACL healing. Two-year outcomes were better in the healed ACL group (n=16) compared with the non-healed (n=14) (mean difference (95\\% CI) KOOS-Sport/Rec: 25.1 (8.6–41.5); KOOS-QOL: 27.5 (13.2–41.8)), delayed ACLR (n=24) (KOOS-Sport/Rec: 24.9 (10.2–39.6); KOOS-QOL: 18.1 (5.4–30.8)) and early ACLR (n=62) (KOOS-Sport/Rec: 17.4 (4.1–30.7); KOOS-QOL: 11.4 (0.0–22.9)) groups. Five-year KOOS-QOL was better in the healed versus non-healed group (25.3 (9.4–41.2)). Of participants with MRI evidence of ACL healing, 63–94\\% met the PASS criteria for each KOOS subscale, compared with 29–61\\% in the non-healed or reconstructed groups.\nConclusions MRI appearance of ACL healing after ACL rupture occurred in one in three adults randomised to initial rehabilitation and one in two who did not cross-over to delayed ACLR and was associated with favourable outcomes. The potential for spontaneous healing of the ACL to facilitate better clinical outcomes may be greater than previously considered.\nTrial registration number ISRCTN84752559.},\n\tlanguage = {en},\n\tnumber = {2},\n\turldate = {2022-11-07},\n\tjournal = {British Journal of Sports Medicine},\n\tauthor = {Filbay, Stephanie Rose and Roemer, Frank W. and Lohmander, L. Stefan and Turkiewicz, Aleksandra and Roos, Ewa M. and Frobell, Richard and Englund, Martin},\n\tmonth = nov,\n\tyear = {2022},\n\tpmid = {36328403},\n\tnote = {Number: 2\nPublisher: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine\nSection: Original research},\n\tkeywords = {Magnetic Resonance Imaging, anterior cruciate ligament, osteoarthritis, quality of life, rehabilitation},\n\tpages = {91--98},\n}\n\n","author_short":["Filbay, S. R.","Roemer, F. W.","Lohmander, L. S.","Turkiewicz, A.","Roos, E. 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