Clinical decisions and implications for treatment of anterior cruciate ligament ruptures and traumatic meniscal tears

The challenge we aim to address in each patient with an ACL rupture is determining
the optimal treatment for each individual at the right moment. Therefore, Chapter 2
investigates why, when and which patients fail non-operative treatment of ACL injury,
by using data from the COMPARE trial. As evidence from high quality RCTs on additional
meniscal injuries after ACL injury is lacking, Chapter 3 evaluates the number of meniscal
procedures in operative and non-operative treatment of ACL injuries.

As mentioned earlier, high quality evidence on treatment of traumatic meniscal tears is
lacking and therefore we performed an RCT in young patients with isolated traumatic
meniscal tears. We randomized them between arthroscopic partial meniscectomy and
non-operative treatment with optional delayed arthroscopic partial meniscectomy
(STARR trial). Chapter 4 describes the clinical outcomes of this RCT after 24 months of
follow-up. Since the optimal treatment of traumatic meniscal tears should not only be
effective, but also cost-effective, Chapter 5 presents the results of a cost-effectiveness
analysis of the STARR trial.

To gain more insight in the effect of isolated traumatic meniscal tears on the knee joint
we studied MRIs of patients in the STARR trial. In Chapter 6 we identify posttraumatic
and OA-related lesions on the MRIs of patients with isolated traumatic meniscal tears at
baseline. To evaluate the effects of operative and conservative treatment of traumatic
meniscal tears on degeneration of the knee joint Chapter 7 assesses the presence of
degenerative changes in the knee joint in patients from the STARR trial at 24-month
follow-up. Together these clinical, cost-effectiveness and radiological outcomes will
contribute to a more evidence based approach of treating young patients with isolated
traumatic meniscal tears.