DOES ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IMPROVE FUNCTIONAL AND RADIOGRAPHIC OUTCOMES OVER NONOPERATIVE MANAGEMENT 5 YEARS AFTER INJURY?

Review written by Christina Le info

BACKGROUND & OBJECTIVE

To operate or not to operate? That is the question when dealing with anterior cruciate ligament (ACL) ruptures. Unfortunately, the answer is not a simple yes or no. Despite evidence of successful outcomes with either operative or non-operative treatment, there still remains a strong bias toward ACL reconstruction following injury.

To inform the answer to this question, clinicians and patients must understand the long-term outcomes of operative and non-operative treatment. In this cohort study, patients who selected ACL reconstruction and those who selected non-operative management were compared on various outcomes 5 years after surgery or completion of non-operative rehabilitation, respectively. Specifically, differences in muscle function, hop performance, patient-reported outcomes, and radiographs were examined.

METHODS

Patients recruited between 2005 and 2011 as part of a completed randomized controlled trial were asked to return for 5-year testing. At the 5-year mark, patients underwent a battery of knee function tests including quadriceps strength (dynamometer), single leg hop, crossover hop, triple single leg hop, timed 6-metre hop, and joint effusion (modified stroke test). In addition, patients completed a variety of questionnaires: Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADLS), global rating scale (GRS) for knee function, International Knee Documentation Committee (IKDC) Subjective Knee Form 2000, Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale (Marx), Tampa Scale for Kinesiophobia (TSK), ACL-Return to Sports After Injury (ACL-RSI) scale, and visual analog scale (VAS) for pain. Lastly, radiographs were completed and medial and lateral tibiofemoral compartments were assessed for the presence of osteoarthritis (Kellgren-Lawrence system and joint space width).

RESULTS

There were 105 patients who returned for 5-year testing. Of those who returned, 83 patients underwent ACL reconstruction and 22 patients selected non-operative rehabilitation. The groups did not differ in age, sex, body mass index, concomitant injuries, or second ACL

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