PhD defence S.J.A. (Sabine) van der Graaff

Brief summary:

Traumatic knee injuries frequently occur among young active people. Common injuries are an anterior cruciate ligament (ACL) rupture and a traumatic meniscal tear. ACL ruptures are typically treated with a surgical ACL reconstruction. As of now, two large randomized controlled trials (RCTs) have been performed, comparing the effectiveness of operative and nonoperative treatment of ACL ruptures. Both studies showed that some of the patients with an ACL rupture can achieve good clinical results with physical therapy alone and do not need a surgical ACL reconstruction. A subset of patients who were treated with physical therapy experienced unsuccessful outcomes and needed an ACL reconstruction at a later time point during follow-up. A common objection to conservative treatment or delayed reconstruction for ACL ruptures is the concern that persistent knee joint instability could result in more damage such as meniscal tears. This thesis explores why some patients with ACL ruptures fail non-operative treatment and investigates whether nonoperative treatment or delayed surgery in ACL ruptures is associated with increased incidence of meniscal injuries. We used data from the COMPARE trial, one of the two RCTs on patients with ACL ruptures to investigate this. The COMPARE trial included 167 patients with an ACL rupture of which 85 patients were randomized to early ACL reconstruction and 82 patients randomized to rehabilitation therapy with the option for delayed ACL reconstruction. Of these 82 patients 41 patients had a delayed ACL reconstruction during the 2-year follow-up period.