前交叉韧带重建相较于非手术管理的最小值得效应：一项获益-风险权衡研究
简介
这是一项获益-风险权衡研究，通过在线问卷评估了92名运动爱好者（休闲或竞技水平）对ACL重建手术的最小值得效应。参与者需回答两个场景：膝关节功能改善和重返运动。基于已发表数据设定保守治疗预期效果，参与者需指出ACL重建相比保守治疗需额外改善多少百分比才值得手术。 关键发现：对于膝关节功能，最小值得效应中位数为12%（IQR 8-16）；对于重返运动，该值高达…
英文摘要
QUESTIONS: What is the estimated smallest worthwhile effect of anterior cruciate ligament (ACL) reconstruction followed by rehabilitation for improving knee function and return to sport compared with rehabilitation only? What are the associations between participant characteristics (age, gender, health insurance status, sports participation level, preference for surgery versus non-surgical management, previous ACL rupture) and these smallest worthwhile effect estimates? DESIGN: Benefit-harm trade-off study conducted via an online survey. PARTICIPANTS: A total of 92 people engaged in recreational or competitive sport. DATA COLLECTION: Participants provided demographic information and answered two benefit-harm trade-off scenarios: a knee function scenario and a return to sport scenario. Participants indicated the minimum additional percentage improvement they would require for ACL reconstruction to be worthwhile compared with the anticipated percentage improvement with rehabilitation only. The expected benefits of rehabilitation only were based on published trial data. Associations between these smallest worthwhile effect estimates and participant characteristics were investigated using univariable regression models. RESULTS: The median smallest worthwhile effect was 12% (IQR 8 to 16) for knee function and 41% (IQR 35 to 47) for return to sport. Smallest worthwhile effects were slightly higher for those participating in competitive sport. Age was associated with smallest worthwhile effect for the knee function scenario (0.3% increase per year older, 95% CI 0.1 to 0.4), although the size of this effect may not be clinically relevant. None of the tested predictors were associated with the smallest worthwhile effect for the return to sport scenario. CONCLUSION: This study is the first to estimate the smallest worthwhile effect of ACL reconstruction. Participants require an additional 12% improvement in knee function or a 41% increase in the likelihood of returning to sport to justify undergoing ACL reconstruction. Therefore, the effects of surgery reported in many studies fall below what patients consider to be worthwhile. REGISTRATION: OSF; https://osf.io/2kn97/.