Does early anterior cruciate ligament reconstruction prevent development of meniscal damage? Results from a secondary analysis of a randomised controlled trial. Snoeker, B. A., Roemer, F. W., Turkiewicz, A., Lohmander, S., Frobell, R. B., & Englund, M. British journal of sports medicine, 54(10):612–617, May, 2020. Place: England
Does early anterior cruciate ligament reconstruction prevent development of meniscal damage? Results from a secondary analysis of a randomised controlled trial. [link]Paper  doi  abstract   bibtex   
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.
@article{snoeker_does_2020,
	title = {Does early anterior cruciate ligament reconstruction prevent development of meniscal  damage? {Results} from a secondary analysis of a randomised controlled trial.},
	volume = {54},
	copyright = {© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and  permissions. Published by BMJ.},
	issn = {1473-0480 0306-3674},
	url = {https://doi.org/10.1136/bjsports-2019-101125},
	doi = {10.1136/bjsports-2019-101125},
	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.},
	language = {eng},
	number = {10},
	journal = {British journal of sports medicine},
	author = {Snoeker, Barbara A. and Roemer, Frank W. and Turkiewicz, Aleksandra and Lohmander, Stefan and Frobell, Richard B. and Englund, Martin},
	month = may,
	year = {2020},
	pmid = {31653779},
	note = {Place: England},
	keywords = {*Time-to-Treatment, ACL, Adult, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Injuries/rehabilitation/*surgery, Anterior Cruciate Ligament Reconstruction, Anterior Cruciate Ligament Reconstruction/*methods, Female, Humans, Magnetic Resonance Imaging, Male, Postoperative Complications, Risk Factors, Tibial Meniscus Injuries, Tibial Meniscus Injuries/diagnostic imaging/*prevention \& control, Time-to-Treatment, Young Adult, knee, knee surgery, meniscus, randomised controlled trial},
	pages = {612--617},
}

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