Surgical Timing and Rehabilitation (STaR) for Multiple Ligament Knee Injuries: Study Protocol for a Multicenter Integrated Clinical Trial.

Multiple ligament knee injuries (MLKIs) often result in persistent pain, residual disability including post-traumatic osteoarthritis, and high healthcare costs. Although nonrandomized and retrospective research supports operative management, evidence informing the optimal timing of MLKI surgery and subsequent rehabilitation is lacking. In addition, return to preinjury military duty, work, and sports after MLKI is poorly understood. The Surgical Timing and Rehabilitation (STaR) Trial for MLKIs was designed to address these gaps in evidence for surgery and postoperative rehabilitation for military personnel and civilians that have a MLKI. The purpose of this protocol paper is to describe the rationale and methodology for the first randomized trials to investigate the impact of timing of surgery and rehabilitation for individuals with a MLKI on time to return to preinjury levels of military duty, work, and sports. The outcomes of the STaR Trial for MLKIs are of paramount importance from the personal and societal perspective of the impact of MLKIs. The optimal time for surgery and timing of postoperative rehabilitation may also reduce residual knee impairments and complication rates that contribute to the development of long-term disability after MLKI.