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Randomized Controlled Trial
. 2020 Jul;28(7):2044-2052.
doi: 10.1007/s00167-019-05397-3. Epub 2019 Feb 14.

Acute reconstruction results in less sick-leave days and as such fewer indirect costs to the individual and society compared to delayed reconstruction for ACL injuries

Christoffer von Essen  1 , Sebastian McCallum  2 , Björn Barenius  2 , Karl Eriksson  2
Affiliations
Randomized Controlled Trial

Acute reconstruction results in less sick-leave days and as such fewer indirect costs to the individual and society compared to delayed reconstruction for ACL injuries

Christoffer von Essen et al. Knee Surg Sports Traumatol Arthrosc. 2020 Jul.

Abstract

Purpose: To compare the total number of sick-leave days caused by the knee injury from the day of injury and over the first year between acute (within 8 days) and delayed (6-10 weeks) anterior cruciate ligament reconstruction (ACLR) and also assess other clinical outcomes during this period.

Methods: Seventy patients with an acute ACL injury and Tegner level of 6 or more were randomized to acute (within 8 days) or delayed (after 6-10 weeks) ACLR. Patient-reported outcomes; objective IKDC and manual stability measurements were assessed at 6 and 12 months. With data from the Swedish Social Insurance Agency (Försäkringskassan) information about the number of sick-leave days due to the knee injury over the following 12 months was collected and compared between the two groups.

Results: Seventy-one percent received compensation for sick leave (26 in the acute versus 23 in the delayed group). The mean number of sick-leave days for the acute group was significantly lower (M = 56.9, SD = 36.4) compared to the delayed group (M = 88.5, SD = 50.2), p < 0.05. The acute group was also significantly stronger in flexion in both slow and fast angle velocities according to Biodex®. No other differences were found between the groups in other clinical assessments or in terms of associated injuries.

Conclusion: Acute and delayed ACLR provided comparable clinical outcomes after 12 months. Acute reconstruction resulted in less sick-leave days and as such fewer indirect costs to the individual and society. These findings suggest that if patients requiring ACLR can be identified early and ACLR can be performed in the acute phase, socioeconomic costs can potentially be reduced by minimizing time off work.

Level of evidence: II.

Keywords: ACL; Acute; Costs; Outcome; Range of motion; Reconstruction.

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Conflict of interest statement

The authors have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Enrollment, randomization and sick-leave compensation of subjects
Fig. 2
Fig. 2
Total amount sick-leave days
Fig. 3
Fig. 3
Postoperative sick-leave days
Fig. 4
Fig. 4
Mean KOOS scores with significant changes after injury to 12 months, but no significant difference between the groups at any time-point
See this image and copyright information in PMC

References

    1. Spindler KP, Wright RW. Clinical practice. Anterior cruciate ligament tear. N Engl J Med. 2008;359:2135–2142. doi: 10.1056/NEJMcp0804745. - DOI - PMC - PubMed
    1. Swedish Knee Ligament Register (2018): “The Swedish National ACL Register”. https://aclregister.nu/media/uploads/Annual%20reports/rapport2016en.pdf. Accessed 18 Dec 2018
    1. Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013;346:f232. doi: 10.1136/bmj.f232. - DOI - PMC - PubMed
    1. Grindem H, Eitzen I, Engebretsen L, Snyder-Mackler L, Risberg MA. Nonsurgical or surgical treatment of ACL injuries: knee function, sports participation, and knee reinjury: the Delaware-Oslo ACL Cohort Study. J Bone Jt Surg Am. 2014;96:1233–1241. doi: 10.2106/JBJS.M.01054. - DOI - PMC - PubMed
    1. Grindem H, Wellsandt E, Failla M, Snyder-Mackler L, Risberg MA. Anterior cruciate ligament injury-who succeeds without reconstructive surgery? The Delaware-Oslo ACL Cohort Study. Orthop J Sports Med. 2018;6:2325967118774255. - PMC - PubMed

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