Description
In this presentation, David Beard discusses the ACL SNNAP study, which compares the clinical and cost effectiveness of two management strategies for non-acute Anterior Cruciate Ligament (ACL) injuries: rehabilitation versus reconstruction. Beard provides an overview of the study's support from the NIHR HTA program and outlines the rationale behind focusing on non-acute injuries, contrasting it with existing research that primarily addresses acute cases.
The study involved a significant team effort across 32 sites with 87 surgeons and 205 rehabilitation personnel, enrolling 320 participants from March 2017 to 2020, achieving an 80% follow-up rate by 2021. Beard notes the importance of non-compliance and crossover from rehabilitation to surgery in the study methodology. He emphasizes the demographic data, revealing a mostly male population with a mean age of 33 years, mainly composed of athletes engaged in contact sports.
Results from the KOOS primary outcome variable reveal a statistically significant advantage for surgical management at the 18-month mark, with reconstruction patients scoring higher than those only receiving rehabilitation. Beard explains that while both groups showed improvements, surgical patients consistently outperformed rehabilitation-only patients, particularly in terms of willingness to undergo surgery again and overall outcomes.
Despite acknowledging the study's limitations, including potential biases related to patient preferences and the arbitrary nature of inclusion criteria, Beard concludes that ACL reconstruction remains a cost-effective treatment in the UK, demonstrating the efficacy of surgical intervention for non-acute ACL injuries while also validating the role of rehabilitation where necessary. He emphasizes the need for evidence-based decision-making and the importance of patient-centered approaches in clinical settings.