Trial reportBritish journal of sports medicine2022
ACL reconstruction for all is not cost-effective after acute ACL rupture.
Trial report in British journal of sports medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 4 syntheses or guidelines pooled it, 60 citations in OpenAlex.
- Cost-Effectiveness of Treatments for Musculoskeletal Conditions Offered by Physiotherapists: A Systematic Review of Trial-Based Evaluations.Sports medicine - open · 2024Pooled it
- "Cost-effectiveness of ACL treatment is dependent on age and activity level: a systematic review".Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Pooled it
- Primary surgery versus primary rehabilitation for treating anterior cruciate ligament injuries: a living systematic review and meta-analysis.British journal of sports medicine · 2022Pooled it
- Non-contact Anterior Cruciate Ligament Injury Epidemiology in Team-Ball Sports: A Systematic Review with Meta-analysis by Sex, Age, Sport, Participation Level, and Exposure Type.Sports medicine (Auckland, N.Z.) · 2022Pooled it
- Comparison of surgical or non-surgical management for non-acute anterior cruciate ligament injury: the ACL SNNAP RCT.Health technology assessment (Winchester, England) · 2024Trial
- Factors Influencing Consultant Knee Surgeons' Decision Making in Anterior Cruciate Ligament (ACL) Injury Management in Athletes: An International Delphi Study.Sports medicine (Auckland, N.Z.) · 2026Article
- Surgical Versus Rehabilitation-First Management Strategies After ACL Injury: Persisting Uncertainty over Long-Term Outcomes-A Systematic Search and Narrative Synthesis of Randomized Trial Cohorts.Healthcare (Basel, Switzerland) · 2026Review
- Injectable Testosterone Replacement Therapy Within 1 Year Before ACL Reconstruction Is Associated With Increased Revision Rates.Orthopaedic journal of sports medicine · 2026Article
- Blood Flow Restriction Training Prior to and After Anterior Cruciate Ligament Reconstruction: A Scoping Review.Journal of functional morphology and kinesiology · 2025Review
- Disparity in anterior cruciate ligament injury management: a case series review across six National Health Service trusts.BMC musculoskeletal disorders · 2025Article
- Traumatic knee injury healthcare pathways and outcomes: the Australian Knee Injury Inception Cohort Study (KIICS) protocol.BMJ open sport & exercise medicine · 2025Article
- Anterior Cruciate Ligament Tear: Individualized Indications for Non-Operative Management.Journal of clinical medicine · 2024Review
- Cost-utility analysis of early reconstruction surgery versus conservative treatment for anterior cruciate ligament injury in a lower-middle income country.BMC health services research · 2024Article
- Modified Implant Fixation Technique Is an Alternative for Patients with an Anterior Cruciate Ligament Tear in Limited Resource Settings: A Comparison Functional Outcome Study with Polyether Ether Ketone and Bioabsorbable Screws.Journal of clinical medicine · 2024Article
- Comparison of immediate versus optional delayed surgical repair for treatment of acute anterior cruciate ligament injury through a parallel, multicentric, pragmatic randomized controlled trial - IODA trial.BMC sports science, medicine & rehabilitation · 2024Article
- Combining return to sport, psychological readiness, body mass, hamstring strength symmetry, and hamstring/quadriceps ratio increases the risk of a second anterior cruciate ligament injury.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Study protocol ROTATE-trial: anterior cruciate ligament rupture, the influence of a treatment algorithm and shared decision making on clinical outcome- a cluster randomized controlled trial.BMC musculoskeletal disorders · 2022Article
- Burden and Cost of Anterior Cruciate Ligament Reconstruction and Reimbursement of Its Treatment in a Developing Country: An Observational Study in Indonesia.ClinicoEconomics and outcomes research : CEOR · 2022Article
- To Reconstruct the Anterior Cruciate Ligament or Not? - Put into Panther Perspective.International journal of sports physical therapy · 2021Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo conduct a cost-utility analysis for two commonly used treatment strategies for patients after ACL rupture; early ACL reconstruction (index) versus rehabilitation plus an optional reconstruction in case of persistent instability (comparator).
methodsPatients aged between 18 and 65 years of age with a recent ACL rupture (<2 months) were randomised between either an early ACL reconstruction (index) or a rehabilitation plus an optional reconstruction in case of persistent instability (comparator) after 3 months of rehabilitation. A cost-utility analysis was performed to compare both treatments over a 2-year follow-up. Cost-effectiveness was calculated as incremental costs per quality-adjusted life year (QALY) gained, using two perspectives: the healthcare system perspective and societal perspective. The uncertainty for costs and health effects was assessed by means of non-parametric bootstrapping.
resultsA total of 167 patients were included in the study, of which 85 were randomised to the early ACL reconstruction (index) group and 82 to the rehabilitation and optional reconstruction group (comparator). From the healthcare perspective it takes 48 460 € and from a societal perspective 78 179 €, to gain a QALY when performing early surgery compared with rehabilitation plus an optional reconstruction. This is unlikely to be cost-effective.
conclusionRoutine early ACL reconstruction (index) is not considered cost-effective as compared with rehabilitation plus optional reconstruction for a standard ACL population (comparator) given the maximum willingness to pay of 20 000 €/QALY. Early recognition of the patients that have better outcome of early ACL reconstruction might make rehabilitation and optional reconstruction even more cost-effective.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.