BACKGROUND & OBJECTIVE
Anterior cruciate ligament (ACL) injuries are common knee injuries that occur during sport. These injuries result in functional impairment, decreased sport participation, reduced quality of life and are associated with the development of post-traumatic knee osteoarthritis (OA). Presently, ACL injuries are managed operatively with ACL reconstruction (ACLR) or nonoperatively. However, no specific treatment option has been established as superior in reducing long-term disability or preventing the development of OA after ACL injuries. This study aimed to compare the long-term outcomes in high-level athletes with ACL injuries who were managed either operatively or nonoperatively.
Patients with ACL injuries and Tegner scores between 7-9 were eligible for inclusion in this study. The Tegner Score is a subjective questionnaire regarding activity level (see image).
All patients were required to complete at least 3 months of a physical therapy exercise program. If patients had persistent symptoms of instability despite rehabilitation, ACLR was offered.
In total, 25 patients underwent ACLR between 1994-1996 and 25 patients who opted for nonoperative management were pair matched with the operative group based on age, sex and Tegner score before injury. Both groups were then followed for 20 years and comparison of outcome measures between the matched pairs were done at 10 and 20-year follow-ups. Outcomes included radiographic x-rays to measure knee OA and generalized OA, patient reported outcomes on function (Lysholm score, IKDC, KOOS, Tegner score), functional stability tests (1-legged hop tests and clinical knee exam) and number of meniscectomies.
Over the 20 years, 1 patient from the nonoperative group underwent delayed ACLR and 4 patients from the operative group had a graft rupture. 1 patient from the operative group had a total knee arthroplasty.