Acute ACL Surgery Decreases First Year Socio Economic Costs Compared to Delayed Reconstruction: A Randomized Controlled Trial

OBJECTIVES: Clinical practice has been to avoid acute ACL reconstruction due to the risk of complications, especially arthrofibrosis. Thus, a general rule has been to wait with reconstruction until he knee is “calm” which usually means 4-8 weeks following injury. Furthermore there is often also a prolonged waiting time due to operating space and other logistic factors. Since most of the patients undergoing ACL reconstruction are of working age, there is a potentially large socio-economic loss due to the fact that many of these patients are unable to work from the time of injury to the time of reconstruction. The aim of this study was to assess and compare the total number of sick leave days caused by the knee injury from the day of injury and over the first year between sub acute and delayed reconstruction. METHODS: 70 patients with high recreational activity level, Tegner level of 6 or more, who presented with an acute ACL injury were randomized to acute reconstruction within 8 days from the injury or delayed reconstruction 6-10 weeks post injury. Four surgeons performed the ACL reconstructions with quadrupled semitendinosus tendon grafts. Patients were assessed at 6,12 and 24 months and these follow ups included Biodex strength test, Lachman, Rolimeter, pivot shift, one leg hop, IKDC, KOOS, Lysholm and Tegner activity level. With data from the Swedish Social Insurance Agency (Försäkringskassan) information about the number of sick leave days from the day of the knee injury and over the following twelve months was collected. The data was recalled based on diagnostic numbers related to the specific knee-injury and compared between the two groups. RESULTS: Seventy percent of the patients were males, mean age at the time of inclusion was 27 years (18 -41) and the pre-injury median Tegner level was 9 (5-10), with no differences between the groups. 15/70 patients were students without registered compensation for sick leave, 5 in the acute and 10 in the delayed group. 4 patients in the acute group and 1 in the delayed group were neither students nor registered for any compensation for sick leave from work. One patient from the delayed group resigned from the study before surgery. The remaining 49 patients, 26 patients in the acute and 23 in the delayed group received compensation for sick leave due to the injury. The number of sick leave days for the acute group was significantly lower, mean 57 (median 53) days compared to the delayed group, mean 99 (median 66) days (p<0.05). CONCLUSION: Acute ACL reconstruction seems to significantly reduce socio economic costs (compensation for sick leave) compared to delayed reconstruction. From a nation based perspective this could have major implications in health care spending.