RCT: Non-operative vs Operative management for ACL injury - The Compare Study, Erasmus Medical Centre

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The Compare Study is a very exciting project currently being conducted at Erasmus Medical Centre, Rotterdam. I met with Dr Max Reijman, Physiotherapist and Primary Investigator and Dr Duncan Meuffels, Orthopaedic Surgeon to discuss this trial.

The Compare Trial is comparing non-operative and operative management effectiveness for ACL injury. This randomised trial has similar inclusion and exclusion criteria and rehab protocols to the KANON trial (conducted by Frobel et al, 2010) and has a 2 year follow up period, using the IKDC score as an outcome measure. A secondary aim of this project is to compare cost effectiveness of the 2 management options.

Final data collection for this trial is almost completed but watch out for the results over the next six months, as will add to our knowledge base of evidence based treatment selection for ACL injured patients. 

Dr Reijman discussed the advantages and disadvantages of each treatment option. Please see a summary below:

Non-operative management

Possible Advantages : Shorter rehabilitation, prevention of unnecessary surgery

Possible disadvantages : Risk of secondary knee damage, risk of instability, risk of delayed surgery

Early operative management

Possible advantages : Successful intervention, less instability, less secondary meniscal tears.

Poss disadvantages : 4-25% failure rates ACLR, surgical complications 3.5%, additional surgical intervention risk, longer rehabilitation time.

The Clinical Translator: Guidelines in The Netherlands for ACL injury recommends that GPs wait for three months before a surgical referral is indicated. During this time exercise and physical activity is recommended. Imaging is only recommended if presenting with a locked knee or if a fracture is  suspected.

As many of you are aware the Kanon trial (Frobel et al, 2010) showed at two and five years there was little difference in outcomes (KOOS score, Tegner activity Scale and Medical Outcome Study 36) between the 3 groups; rehabilitation alone, early reconstruction and rehabilitation and delayed reconstruction if required.

This is the only RCT which has been done to date comparing these treatment groups for ACL injury so we look forward to The Compare Study to see if the Kanon results are repeated.

I am also interested in the 10 year Kanon results with respect to OA, meniscal tear and instability rates so we can start to understand the long term implications of treatment options for our ACL patients.

 It is my opinion that patients need to be well informed of the advantages and disadvantages of each treatment option so they can make an informed decision re an appropriate individually tailored management plan with short and long term risks and benefits considered.     


This is intended as an aid to the clinician to translate research findings into clinical practice but is my own opinion based on the available current research evidence and my clinical expertise and experience. Clinicians should consider if this advice is appropriate for them and use their own reasoning processes considering the individual patient in question