(R)esearch in (A)cute vs (D)elayed (A)CL (R)econstruction

An anterior cruciate ligament (ACL) rupture is a common injury of the knee in
sports with many pivoting movements such as football, handball, volleyball and
basketball. In case of instability of the knee and the desire of the patient to
return to his / her pre-injury level of sports, a surgical reconstruction of
the ACL is recommended. Current guidelines recommend first 3 months of
physiotherapy before an ACL reconstruction is performed. However, because of
improvements in arthroscopy and physiotherapy, it is possible to perform an ACL
reconstruction within the first weeks following the injury. Potential added
value of early ACL reconstruction may be that a patient has less loss of
function of the knee and may also return earlier to his / her pre-injury level
of activity. Secondary, it is expected that early ACL reconstruction will
result in a significant cost reduction because physical therapy prior to ACL
reconstruction is shortened and it is expected that the postoperative treatment
process also will be shorter. The little scientific research that has been done
on this subject, confirm that an earlier timing of ACL reconstruction results
in comparable or better outcome, compared to the ususal timing. However, the
evidence is scarce and no RCT has been conducted on this subject.

To investigate the (cost) effectiveness of early ACL reconstruction (<6 weeks
after injury), compared to the usual timing of ACL reconstruction (> 3 months
after injury). Hypotheis is that early ACL reconstruction results in less loss
of function and muscle strength of the knee and in an faster return to the
pre-injury level of activity.

A prospective randomized multicenter study. Timing of ACL reconstruction
(within 6 weeks or after three months following injury) will be randomly
determined. Patients are enrolled in 12 participating clinics.

Early ACL-reconstruction (< 6 weeks) vs delayed ACL-reconstruction (> 3 months)

Results of this study will contribute to the optimization of the treatment of
patients with an ACL injury. It is expected that the risks associated with
participation in the study are negligible. The research involves only a change
in timing of surgery (ACL reconstruction) that has proven to be effective and
safe. A possible risk to participation in the study is the risk of
artrofibrosis at an early ACL reconstruction. However, since a preoperative
extension and flexion limitation is an exclusion criteria, it is expected that
the probability of the occurrence of artrofibrosis in the group receiving early
ACL reconstruction will undergo will be just as large as in the group operated
at 3 months after injury. The risks associated with the measurements made in
this study are negligible, since the measurements are similar to physical
exercises and workouts that patients after ACL reconstruction perform during
physiotherapy as part of their rehabilitation.