Grindem H. J Bone Joint Surg Am. 2014. doi:10.2106/JBJS.M.01054.
August 19, 2014
Minimal differences in outcomes and re-injury risks were seen between patients with ACL ruptures treated with or without surgery, according to recently published data.
Researchers conducted a prospective cohort study of 143 patients from the Norwegian Sports Medicine Clinic who sustained an ACL rupture between 2007 and 2011. Patients were divided into two groups: group A (100 patients treated surgically) and group B (43 treated nonsurgically). The researchers collected and evaluated self-reported sports participation, knee re-injuries, isokinetic knee extension and flexion strength, and self-reported knee function via the IKDC 2000 at baseline, 6 weeks and 2 years.
Twenty percent of all patients reported sustaining a knee re-injury at final follow-up; 24 patients (24%) from group A reported 34 knee re-injuries and four patients (9%) from group B reported seven knee re-injuries. Thirty percent of all patients had extensor strength deficit, 31% had flexor strength deficit and 20% reported knee function below the normal range at final follow-up.
Patients in group A tended to be younger and more likely to participate in level-I sports, but less likely to participate in level-II sports prior to injury compared with patients in group B. Postoperatively, patients in group B were shown to be significantly more likely to participate in level-II sports during the first year of follow-up and in level-III sports during the second year of follow-up, according to the researchers.
No significant group-by-time effects on functional outcome were reported.
Disclosure: See the study for a full list of all authors’ relevant financial disclosures.
Nonsurgical or Surgical Treatment of ACL Injuries: Knee Function, Sports Participation, and Knee Reinjury
The Delaware-Oslo ACL Cohort Study
Hege Grindem, PT, PhD
J Bone Joint Surg Am, 2014 Aug 06;96(15):1233-1241. http://dx.doi.org/10.2106/JBJS.M.01054
ABSTRACT
Background: While there are many opinions about the expected knee function, sports participation, and risk of knee reinjury following nonsurgical treatment of injuries of the anterior cruciate ligament (ACL), there is a lack of knowledge about the clinical course following nonsurgical treatment compared with that after surgical treatment.
Methods: This prospective cohort study included 143 patients with an ACL injury. Isokinetic knee extension and flexion strength and patient-reported knee function as recorded on the International Knee Documentation Committee (IKDC) 2000 form were collected at baseline, six weeks, and two years. Sports participation was reported monthly for two years with use of an online activity survey. Knee reinjuries were reported at the follow-up evaluations and in a monthly online survey. Repeated analysis of variance (ANOVA), generalized estimating equation (GEE) models, and Cox regression analysis were used to analyze group differences in functional outcomes, sports participation, and knee reinjuries, respectively.
Results: The surgically treated patients (n = 100) were significantly younger, more likely to participate in level-I sports, and less likely to participate in level-II sports prior to injury than the nonsurgically treated patients (n = 43). There were no significant group-by-time effects on functional outcome. The crude analysis showed that surgically treated patients were more likely to sustain a knee reinjury and to participate in level-I sports in the second year of the follow-up period. After propensity score adjustment, these differences were nonsignificant; however, the nonsurgically treated patients were significantly more likely to participate in level-II sports during the first year of the follow-up period and in level-III sports over the two years. After two years, 30% of all patients had an extensor strength deficit, 31% had a flexor strength deficit, 20% had patient-reported knee function below the normal range, and 20% had experienced knee reinjury.
Conclusions: There were few differences between the clinical courses following nonsurgical and surgical treatment of ACL injury in this prospective cohort study. Regardless of treatment course, a considerable number of patients did not fully recover following the ACL injury, and future work should focus on improving the outcomes for these patients.