Accès ouvert déclaré
2022
article
Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial
David John Beard, Loretta J Davies, Jonathan Alistair Cook, Jamie R. Stokes, José Leal, Heidi Fletcher, Simon G. F. Abram, Katie Chegwin, Akiko Greshon, William F. Jackson, Nicholas Bottomley, Matt Dodd, Henry Edmund Bourke, Beverly A. Shirkey, Arsenio Páez, Sarah E Lamb, Karen Louise Barker, Michael Phillips, Mark T. Brown, Vanessa Lythe, Burhan Mirza, Andrew Jonathan Carr, Carlos Morgado Areia, Sean O’Leary, Fares Sami Haddad, Chris Wilson, Andrew James Price, Richard A Emsley, George Peat, Martyn Snow, Marion Campbell, Tessa Howell, Hilary M. Johnson, Stephen John McDonnell, Thomas D Pinkney, Mark Rees Williams, Helen Campbell, Jackie Davies, Jiyang Li, C. Bagg, Laura Haywood, Anne Nicholson, Joanne Riches, Sean P. Symons, Mark Vertue, Louay Al Mouazzen, Rachel Bray, Damian A. Clark, James Coulthard, Tim J. B. Holland, Nick Howells, Andrew K. Jones, Richard Kapur, Alastair Kiszely, Harry Krishnan, Karen MacDonald-Taylor, Jon Manara, James Lee Murray, Corina Negrut, Vishai Pai, Andrew J. Porteous, Sven Putnis, James Leland Robinson, Veenesh Selvaratnam, James Q. Smith, Jarrad M. Stevens, Clare J Taylor, Anthony A. Theodorides, Niraj Vetharajan, Helen Vint, LUCY H. Y. YOUNG, Susan Bullock, Rebecca L. Cook, Alexander L. Dodds, Amanda Freeman-Hicks, Paula Hillout, Thomas Andrew Cornell, Abbie Coutts, Suzy Dean, Nicki Devooght-Johnson, Emma Ferrell, Eve Fletcher, Benjamin Kent, Sandra Kessly, Robin Kincaid, Mohamed Lazizi, Ahmed Mostafa, Toby Nisbett, Timothy J. Powell, P Riddlestone, Andrew Roberton, Jessica J. Summers, Lucy Whitbread, Belinda Wroath, Emma Fenlon, Helen Jeffrey, Raghuram Thonse, Debra Dunne, Kerri McGowan, Simon Middleton, Feisal Shah, Tim Spalding, Charlie Marie Suddens, Tamar Sweed, Joanna Teuke, Peter M. Thompson, David John Wright, Justine Amero, Emma Brown, Hugh R. Chissell, Andrea Croucher, Gareth Dickinson, Catherine Hawkes-Blackburn, Alice Peacocke, Graham P. Smith, Carol Snipe, Kim Dearnley, Reza Mayahi, Barry J. Andrews, Massimo Barcelona, Hazel Giles, Abdulkerim Gokturk, Paul R. Harnett, Katie Jeeves, Joyce Kadunyi, Sheena Mendoza, Ines L. H. Reichert, M López Santamaría, Harshinder Virdee, Sanjeev Anand, Nayef Aslam-Pervez, Stephen Draycott, Faye Howarth, Irfan Jina, Niall Maher, Denise H. Ross, Lindsey Worstenholme, Abdul Mannan Baig, Arun Bhaskaran, Daniel Banks, Tracy Brear, C. Christie, Laura L. E. Cowen, Jack Davis, Ross Dixey, Colin N.A. Esler, Amirah Essop-Adam, Christina Haines, Linzy Houchen‐Wolloff, Husein Varachia, Richard T. A. Wood, Glaxy Gray, Jessica E. Nichols, Alice Panes, Susan Partridge, Pankaj Sharma, David Triggs, Ian Venables, Danielle Wilcock, Sarah A. Buckley, Thelma Darian, Elizabeth H. Denis, J. M. Bunn and G. A. Duncan, Charlotte M. Hirst, James P. Newman, Fern Richardson, J. Gustav Smith, Megan Adcode, Megan Cottingham, Eliza Foster, Andrew Kelly, Niamh McKay, J Rewbury, Alison Whitcher, James Leigh Williams, Esther Zebracki, Llinos Davies, Jayadeep Jayachandran, Alison Tardivel, Victoria Whitehead, Martha Batting, Amy Bond, Marc Deakin, Christopher Dodd, Alison Hudak, Samantha Hynes, Luke D. Jones, Gail Lang, David S. McKenna, Susan Morris, Clare Scott-Dempster, Iason Vichos, Simon M. Wood, Rupert Clifton, Stephanie Diaz, Craig Hendy, Nishil Modi, Brendan M. O’Mahony, Susan B. O'Sullivan, Nicola Parker, Mira Pecheva, Rowan Rumonovic, Emma McLoughlin, Jeremy L. Rushbrook, Anna Thornhill, Valerie Parkinson, Rafael Sales, Katja Van De Snepscheut-Jones, D.J. Wilcock, Daniel R. Wright, Joanna Allison, Simon J Baker, Kate Beesley, Gill Ferrari, Benedict J.A. Lankester, Alison Lewis, Joanne Lyons, Jamie O’Callaghan, Sarah Sutcliffe, Dianne Wood, Emily A. Bannister, Chloe L. Brown, Debbie Burden, Terence J. Campbell, Emma Craig, Rashmi Easow, Julie Foxton, Alexandra Hazlerigg, Chethan Jayabev, Rosie Murdoch, Georgie Parsons, Harry Brown, Paula Carvelli, Rugaia Montaser, A R Pepper, Sinduja Sivarajan, Oliver Templeton-Ward, Eva Wilson, Julie Cronin, Sarah Diment, Victoria L. King, Katharine Shean, Leonidas Vachtsevanos, Katharine Wilcocks, Ben Wilson, Paul McNestry, Joanna Ollerenshaw, James E. Stoddard, Paul Mark Sutton, Sanjay Anand, Judith A. Bell, Albert Chikate, Diane S. Daniel, Timothy Davies, Tom Finnigan, Antonio Frasquet-Garcia, Susan Hopkins, Sharon Kerrison, Angela McGowan, David Sands Johnson, Lara Smith, Philip Gartside Turner, Helen Wilkinson, Lynne Allsop, Deborah Anthony, Rebecca L. Boulton, Sarah Brown, Vikram Desai, Mandy Gill, Cheryl Heeley, Sushrut Kulkarni, Wayne Lovegrove, Dominic Nash, Terri Ann Sewell, Sarah C. Shelton, Katie Slack, James E. Cartwright, Lynda Connor, Andrew John Davies, Caroline Davies, Glyn Gainard, Dave Graham-Woollard, Carl Murphy, Leanne Quinn, Caradog Thomas, Jenny Travers, Marie Williams, Amanda M. Bell, Sunny D. Deo, Katharine Francis, Tracy Jackson, Laura McCafferty, Basalingappa Navadgi, Karan Plank, Claire Thelwall, Rachel Knight, Rahul D. Patel, Bruce M. Paton, Ashutosh Acharya, Utuman Aland, Miltiades Areirobulos, P. de Feyter, Lisa Ditchfield, Hafiz Iqbaz, D. Anthony Massey, Gareth Stables, Sarah Appleby, Michael D. Brown, Sarah Cable, A. Damen, Joana Da Rocha, Louise C. Foster, Elizabeth Hamilton, Catriona Hatton, C Honeywell, Kunal Kulkarni, Lucy Markham, Haadiya Mohammed, John O’Grady, Yogesh V. Joshi, Heather Mclintock, Tania Morgan, Jane Stockport, Pranshu Agrawal, Jo Armstrong, Shannon L. Briggs, Ben Coupe, Anne Evans, Rob Gilbert, Sandra Latham, Aslam Mohammed
139Citations signalées, ce qui n’est pas une note de qualité
16Institutions déclarées
1Pays d’affiliation déclarés
Rattachement africain : gb.
Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
BACKGROUND: Anterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability. METHODS: We did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score-4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367. FINDINGS: Between Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5-13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications. INTERPRETATION: Surgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management. FUNDING: The UK National Institute for Health Research Health Technology Assessment Programme.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial
- Date Crossref
- 01/08/2022
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Nuffield Orthopaedic Centre
pays non établi dans la notice
Établissement de santé
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University of Oxford
Botnar Research Centre
pays non établi dans la notice
Université ou école supérieure
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Swansea Bay University Health Board
pays non établi dans la notice
Établissement de santé
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Wexham Park Hospital
pays non établi dans la notice
Établissement de santé
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Frimley Health NHS Foundation Trust
pays non établi dans la notice
Établissement de santé
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University of Exeter
pays non établi dans la notice
Université ou école supérieure
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Royal Berkshire Hospital
pays non établi dans la notice
Établissement de santé
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Royal Berkshire NHS Foundation Trust
pays non établi dans la notice
Établissement de santé
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University College Hospital
pays non établi dans la notice
Établissement de santé
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University College London Hospitals NHS Foundation Trust
pays non établi dans la notice
Établissement de santé
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University College London
pays non établi dans la notice
Université ou école supérieure
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Cardiff and Vale University Health Board
pays non établi dans la notice
Établissement de santé
Nuffield Orthopaedic Centre, Botnar Research Centre — University of Oxford et Swansea Bay University Health Board, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.
Les sujets associés
Knee injuries and reconstruction techniquesTotal Knee Arthroplasty OutcomesOsteoarthritis Treatment and Mechanisms