Anouk Urhausen is a doctorate student at the Department of Sports Medicine. On October 10, 2024, 10:15—16:00 she will defend her thesis After a decade of the Delaware-Oslo ACL Cohort treatment algorithm: Measurement properties and outcomes after reconstruction or rehabilitation alone for anterior cruciate ligament injury at the Norwegian School of Sport Sciences, Auditorium Innsikt.
About the study
Anterior cruciate ligament (ACL) injuries are either treated surgically (with ACL reconstruction; ACLR) or nonsurgically (with rehabilitation alone). High-quality studies are scarce but show similar outcomes after both treatment strategies.
However, the treatment choice is only one part of the treatment process: intense rehabilitation, surgical indications, and patient education are also essential. Additionally, ACL patients are a heterogeneous group and do not follow a one-size-fits-all approach.
To improve treatment decision and patient outcomes, we need to evaluate long-term outcomes of patients who followed a specific treatment plan, including intense rehabilitation before making an informed treatment decision.
First, we calculated thresholds determining satisfactory patient-reported outcomes for ACL-injured patients. Additionally, we summarised and appraised the measurement properties of knee muscle strength test outcomes to identify the most valid and reliable strength tests for patients with ACL injury.
We then described the 10-year outcomes of patients who followed a specific treatment algorithm, and compared outcomes between patients who chose early ACLR, delayed ACLR, or rehabilitation alone. The outcomes included patient-reported outcomes, muscle strength, hop performance, sports participation, and knee osteoarthritis.
Lastly, we compared these patient-reported outcomes with those of patients from the Norwegian Knee Ligament Registry who followed usual care at the 10-year follow-up after ACLR.
Results
We calculated valid thresholds to determine satisfactory outcomes at the 10-year follow-up after ACL injury. We further identified isokinetic concentric muscle strength tests as the most recommended, with isotonic strength tests being a good alternative.
Patients after ACL injury who followed our treatment algorithm had high percentages of satisfaction, symmetrical muscle strength and knee function, high sports participation rates, and low prevalence of knee osteoarthritis.
Participants who underwent progressive rehabilitation alone or early ACLR did equally well on all outcomes. Participants who underwent delayed ACLR reported lower knee-related function, quality of life, and hop performance compared to the other two treatment groups.
Patients who followed our treatment algorithm reported lower symptoms, higher knee function, and higher percentages of satisfaction compared to those who followed usual care. Overall, the Delaware-Oslo ACL Cohort treatment algorithm likely holds potential to optimise long-term outcomes after ACLR compared to usual care.
Read the thesis here
Committee
- Professor Kari Bø, Norwegian School of Sport Sciences (NIH), chairperson
- Associate professor Sofi Sonesson, Department of Health, Medicine and Caring Sciences, Linköping University
- Professor Kristian Samuelsson, Department of Orthopedics, University of Gothenburg
Supervisors
- Hege Grindem, PhD; Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo
- Prof Lynn Snyder-Mackler, ScD; Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
Program
- 10.15-11.00: Trial lecture
- 11.00-16.00: Public defense of the thesis: After a decade of the Delaware-Oslo ACL Cohort treatment algorithm: Measurement properties and outcomes after reconstruction or rehabilitation alone for anterior cruciate ligament injury
Practical info
The public defence is open to the public and will be streamed on the NIH’s YouTube channel.
