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Early vs. Delayed Treatment of Anterior Cruciate Ligament Tears


Am Fam Physician. 2011 Apr 1;83(7):842-844.

Background: An anterior cruciate ligament (ACL) tear is associated with joint instability, decreased activity, and an increased risk of developing osteoarthritis of the knee. Although treatment usually involves early surgical reconstruction combined with physical therapy, it is unclear whether this improves clinical outcomes. Frobell and colleagues performed a randomized controlled trial to determine if rehabilitation with early ACL reconstructive surgery was more effective than rehabilitation with delayed ACL reconstructive surgery.

The Study: The authors recruited 121 healthy persons 18 to 35 years of age presenting with a new ACL injury to participate in the Knee Anterior Cruciate Ligament, Non-surgical versus Surgical Treatment Study. All participants received physical rehabilitation, but were randomized to receive early ACL reconstructive surgery within 10 weeks postinjury, or to be monitored for up to two years with the option for ACL repair surgery if they remained symptomatic. Persons with total collateral ligament rupture and full-thickness knee cartilage lesions were excluded. The primary outcome was the change from baseline to two years in the average Knee Injury and Osteoarthritis Outcome Score regarding pain, symptoms, difficulty in sports and recreational activities, and quality of life.

Results: Of the 59 participants in the delayed reconstruction group, 23 ultimately received ACL reconstructive surgery an average of 11.6 months after randomization. Both groups showed similar clinical improvement, with no significant differences in the score between groups during the two-year period. No differences were noted between groups regarding knee-related outcomes or the return to preinjury activity levels.

Conclusion: The authors conclude that for acute ACL tears in young, active adults, structured rehabilitation with optional delayed reconstructive surgery results in similar clinical outcomes compared with an early ACL repair strategy. In this study, surgery was avoided in 61 percent of the delayed reconstruction group, without adversely affecting outcomes.


Frobell RB, et al. A randomized trial of treatment for acute anterior cruciate ligament tears [published correction appears in N Engl J Med. 2010;363(9):893]. N Engl J Med. July 22, 2010;363(4):331–342.



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