A study that was published in January 2013 in the British Medical Journal is raising provocative questions about how to best treat a torn anterior cruciate ligament (ACL). The researchers from Lund University, Sweden recruited 121 young active volunteers with acute ACL injuries. They were randomly assigned into one of two groups. Sixty-two patients were assigned to early ACL reconstruction and fifty-nine were assigned to conservative treatment with the option of having delayed ACL reconstruction if needed.
Thirty (51%) patients assigned to optional delayed ACL reconstruction had delayed ACL reconstruction. All reconstructions were single bundle, done by using either a patella tendon or hamstrings tendon procedure depending on the surgeon’s preference. The ACL’s that were reconstructed with the patella tendon were found to have more osteoarthritis than those that received the hamstring tendon autograft procedure.
Over the five-year period, the knees were reassessed using a comprehensive numerical score that rated pain, function during activity and other measures. Both groups had shown significant improvements and there were no considerable difference between a strategy of rehabilitation plus early ACL reconstruction at five years than a strategy of initial rehabilitation with the option of having a later ACL reconstruction. The main difference was that mechanical knee stability (i.e., Lachman and pivot shift test) was significantly better in knees assigned to early ACL surgery.
It has always been thought that surgery leads to a stronger knee, however these results should encourage clinicians and young active adult patients to consider rehabilitation as a primary treatment option after an acute ACL tear. The authors concluded that more than half the ACL reconstructions currently being undertaken on injured knees could be prevented without affecting the outcomes.
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Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, & Lohmander LS (2013). Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial.
BMJ (Clinical research ed.), 346 PMID: 23349407