There is no good evidence for how early or delayed surgery will affect your time to return to full activity after treatment for your multiple ligament knee injury.
If the surgery is done within 6 weeks (early surgery), there is an increased chance of knee joint stiffness which can slow progress considerably. If surgery is done more than 3 months after injury there is a smaller chance of stiffness, so rehab may be smoother.
Many patients are concerned that waiting until 12 weeks after injury to have surgery will greatly delay their return to work, sports, or military duty. However, delayed surgery is the preferred option for many of the surgeons participating in this study. It is also possible that undergoing 12 weeks after injury will have made the knee ready for surgery. (See question 3).
There is no good evidence for how early or delayed rehabilitation will affect your time to return to full activity after treatment for your multiple ligament knee injury.
Typically, we do not start range of motion exercises and weight bearing until 4 weeks after surgery to let healing occur and to protect the repaired structures, but delayed rehabilitation may contribute to greater stiffness of the knee, which can slow down your recovery timeline. However, if we start range of motion exercises and weight bearing right away it may contribute to more feelings of looseness in the knee which may make full activity more difficult.
Multiple ligament knee injuries are serious and variable. Many times after a MLKI, the knee is swollen and range of motion can be very limited. If surgery is performed when the knee is swollen and motion is not full, this may contribute to excessive knee stiffness after surgery. If you are randomized to delayed surgery, there is more time to resolve swelling, restore range of motion, and increase muscle strength, all of which have the potential to improve your post-surgical outcome.
In short, if your surgery is delayed until 12 weeks after injury, it does not mean that you cannot do anything to help your knee until 12 weeks.
If you have surgery early, there is a chance you can get back to activity more quickly than with delayed surgery. However, because there is a greater chance for stiffness after early surgery, there is also a chance that your rehab will be more difficult and that you will have a prolonged time to return to full activity. Simply put, there is more variability in return to activity after early surgery.
Each surgeon has his own preference for when to do surgery and when to start rehabilitation, so this answer will depend on your particular surgeon. Each surgeon who has agreed to offer his/her patients participation in this study has agreed that no one knows the ideal time to perform surgery or when to start rehabilitation after surgery. This is a position of clinical equipoise – each option has an equal position.
If you choose not to participate in the study, the decision for when to perform surgery and when to start rehabilitation will be decided in a conversation between you and your surgeon. Your surgeon may recommend either early or late surgery and early or delayed rehabilitation based on his/her standard clinical practice and your individual scenario.
Whether or not you provide your consent for participation in this research study will have no effect on your current or future medical care at this hospital or with an affiliated health care provider. You may discuss your care with another doctor who is not associated with this research study. You are under no obligation to participate in any research study offered by your doctor.
In Trial 1, we will recruit 392 people to participate. In Trial 2, we will recruit 298 people to participate.
As of November of 2018, we have recruited 2 people to participate in Trial 1, and 1 person to participated in Trial 2.
Starting six months after your randomization, you will complete brief remote research follow-ups every month. You can get the information by e-mail, phone, or postal mail. The brief monthly questions should take no more than 10 minutes of your time. You will complete these each month from 6 months after randomization to 24 months after randomization. You will be compensated $10 each time you complete one of the monthly assessments.
You will complete full remote research follow-ups by e-mail or postal mail 6 months, 12 months, and 24 months after randomization. These longer assessments should take 40 to 45 minutes of your time. You will be compensated $35 each time you complete one of the full assessments.
In Trial 1 (Randomization of Timing of Surgery and Timing of Rehabilitation), randomization occurs when you sign the Consent Form and are deemed fully eligible to participate.
In Trial 2 (Randomization of Timing of Rehabilitation), randomization occurs when you have surgery.
If you want to change the e-mail that we use to send you outcome questionnaires, please let us know by using this form.