Smallest worthwhile effect of anterior cruciate ligament reconstruction compared with non-surgical management: a benefit-harm trade-off study

IF 9.4 1区医学 Q1 ORTHOPEDICS

Journal of Physiotherapy Pub Date : 2026-07-01 Epub Date: 2026-06-22 DOI:10.1016/j.jphys.2026.05.006

Fahd Dibsh, Giovanni E Ferreira, Chris G Maher, Adam Culvenor, Evangelos Pappas, Harrison J Hansford, Simon Hall, Joshua R Zadro

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引用次数: 0

Abstract

Questions

What is the estimated smallest worthwhile effect of anterior cruciate ligament (ACL) reconstruction followed by rehabilitation for improving knee function and return to sport compared with rehabilitation only? What are the associations between participant characteristics (age, gender, health insurance status, sports participation level, preference for surgery versus non-surgical management, previous ACL rupture) and these smallest worthwhile effect estimates?

Design

Benefit-harm trade-off study conducted via an online survey.

Participants

A total of 92 people engaged in recreational or competitive sport.

Data collection

Participants provided demographic information and answered two benefit-harm trade-off scenarios: a knee function scenario and a return to sport scenario. Participants indicated the minimum additional percentage improvement they would require for ACL reconstruction to be worthwhile compared with the anticipated percentage improvement with rehabilitation only. The expected benefits of rehabilitation only were based on published trial data. Associations between these smallest worthwhile effect estimates and participant characteristics were investigated using univariable regression models.

Results

The median smallest worthwhile effect was 12% (IQR 8 to 16) for knee function and 41% (IQR 35 to 47) for return to sport. Smallest worthwhile effects were slightly higher for those participating in competitive sport. Age was associated with smallest worthwhile effect for the knee function scenario (0.3% increase per year older, 95% CI 0.1 to 0.4), although the size of this effect may not be clinically relevant. None of the tested predictors were associated with the smallest worthwhile effect for the return to sport scenario.

Conclusion

This study is the first to estimate the smallest worthwhile effect of ACL reconstruction. Participants require an additional 12% improvement in knee function or a 41% increase in the likelihood of returning to sport to justify undergoing ACL reconstruction. Therefore, the effects of surgery reported in many studies fall below what patients consider to be worthwhile.

Registration

OSF; https://osf.io/2kn97/

查看原文本刊更多论文

与非手术治疗相比，前交叉韧带重建的最小价值效果：一项利-弊权衡研究。

问题：与单纯康复相比，前交叉韧带（ACL）重建后康复对改善膝关节功能和恢复运动的最小有价值的效果是什么？参与者特征（年龄、性别、健康保险状况、运动参与水平、手术与非手术治疗的偏好、前ACL破裂）与这些最小有价值的效果估计之间有什么关联？设计：通过在线调查进行的益害权衡研究。参与者：共92人从事娱乐或竞技体育。数据收集：参与者提供了人口统计信息，并回答了两种利弊权衡方案：膝关节功能方案和重返运动方案。参与者表示，与仅进行康复治疗的预期改善百分比相比，ACL重建所需的最小额外改善百分比是值得的。康复的预期益处仅基于已公布的试验数据。使用单变量回归模型研究了这些最小值效应估计与参与者特征之间的关联。结果：膝关节功能的中位最小有价值效果为12% (IQR 8至16)，恢复运动的中位最小有价值效果为41% （IQR 35至47）。对于那些参加竞技体育的人来说，最小的有价值的影响略高。年龄对膝关节功能的影响最小（年龄增加0.3%,95% CI 0.1 - 0.4），尽管这种影响的大小可能与临床无关。没有一个被测试的预测因素与最小的有价值的影响有关。结论：本研究首次估计了ACL重建的最小价值效果。参与者需要另外12%的膝关节功能改善或41%的恢复运动的可能性增加才能证明进行前交叉韧带重建是合理的。因此，许多研究报告的手术效果低于患者认为值得的效果。注册:OSF;https://osf.io/2kn97/。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Physiotherapy ORTHOPEDICS-REHABILITATION

CiteScore

11.40

自引率

7.40%

发文量

审稿时长

72 days

期刊介绍： The Journal of Physiotherapy is the official journal of the Australian Physiotherapy Association. It aims to publish high-quality research with a significant impact on global physiotherapy practice. The journal's vision is to lead the field in supporting clinicians to access, understand, and implement research evidence that will enhance person-centred care. In January 2008, the Journal of Physiotherapy became the first physiotherapy journal to adhere to the ICMJE requirement of registering randomized trials with a recognized Trial Registry. The journal prioritizes systematic reviews, clinical trials, economic analyses, experimental studies, qualitative studies, epidemiological studies, and observational studies. In January 2014, it also became the first core physiotherapy/physical therapy journal to provide free access to editorials and peer-reviewed original research. The Australian Physiotherapy Association extended their support for excellence in physiotherapy practice by sponsoring open access publication of all Journal of Physiotherapy content in 2016. As a result, all past, present, and future journal articles are freely accessible, and there are no author fees for publication.