Anterior cruciate ligament tears: conservative or surgical treatment? A critical review of the literature

Delince, Philippe; Ghafil, Dior

doi:10.1007/s00167-011-1614-x

Cited by 126 publications

(111 citation statements)

References 111 publications

(199 reference statements)

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“…ACL dysfunction is considered to be one of the major risk factors of knee OA [1,9,14,15,17,18,29,30]. When the ACL is injured, not only tibio-femoral OA, but also PF-OA progression is seen in long-term follow up [11,23,30].…”

Section: Discussionmentioning

confidence: 99%

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Anterior cruciate ligament deterioration correlates with patella osteoarthritis

Iriuchishima¹,

Ryu

Aizawa

et al. 2013

International Orthopaedics (SICOT)

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Purpose The correlation between anterior cruciate ligament (ACL) condition and patella osteoarthritic (OA) changes has not been well reported. The aim of this study was to reveal the correlation between ACL deterioration and the morphology of OA changes in the patella. The hypothesis was that significant correlation between ACL deterioration and patella OA morphology would be revealed in this study. Methods Two hundred ninety-one cadaveric knees from 151 cadavers were included in this study with a median age of 83 years (54-98). Knees were opened with a sub-vastus approach and the ACL condition was classified as intact or deteriorated. Patella OA lesions were classified using Han's method: type 1, no or minimal lesion; type 2, medial facet lesion without involvement of the ridge; type 3, lateral facet lesion without involvement of the ridge; type 4, lesion involving the ridge only; type 5, medial facet lesion with involvement of the ridge; type 6, lateral facet lesion with involvement of the ridge; and type 7, global lesion. OA depth evaluation was performed following Outerbridge's classification. Statistical analysis of the collected data was performed using generalized estimating equations (GEE). Results The ACL was intact in 277 knees and deteriorated in 14 knees. Patella OA lesions were observed as follows: type 1, 29 %; type 2, 15 %; type 3, 2 %; type 4, 12 %; type 5, 18 %; type 6, 2 %; and type 7, 22 %. Outerbridge's classification of over grade 2 OA depth was observed in 73.5 % of subjects. When patella OA was divided into types 1-4 and types 5-7, ACL deterioration was correlated with the occurrence of type 5-7 patella OA [OR 6.44, 95%CI 2.27-18.25, p =0.000]. When patella OA was divided into types 1-6 and type 7, ACL deterioration was correlated with the occurrence of type 7 patella OA [OR 6.02, p =0.000]. When patella OA depth was divided into grades 1-3 and grade 4, ACL deterioration was highly correlated with the occurrence of grade 4 patella OA [OR 9.31, p =0.025]. Conclusion ACL deterioration is a strong risk factor of wider and deeper OA changes in the patella. For clinical relevance, subjects with ACL tear should be aware of the progression of patella OA.

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Section: Discussionmentioning

confidence: 99%

“…It is believed that anterior cruciate ligament (ACL) dysfunction can be a cause of patello-femoral (PF) osteoarthritic (OA) changes [1][2][3][4]. PF-OA is one of the most severe causes of knee pain in the elderly population [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Anterior cruciate ligament deterioration correlates with patella osteoarthritis

Iriuchishima¹,

Ryu

Aizawa

et al. 2013

International Orthopaedics (SICOT)

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“…As much as the surgical reconstruction is the obvious indication in these cases, there is no consensus that the intervention is superior to the conservative physical therapy treatment 2,3 . The rate of return to sports is also similar, between 8 and 82% in patients undergoing surgery and between 19 and 82% in patients who did not undergo surgical reconstruction 4 .…”

Section: Introductionmentioning

confidence: 99%

Physical therapy in the conservative treatment for anterior cruciate ligament rupture followed by contralateral rupture: case report

Almeida

Arruda²,

Marques³

2014

Fisioter. Pesqui.

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| Although the surgical reconstruction be the obvious indication for the anterior cruciate ligament (ACL) lesion, there is no consensus on whether the results of surgery are superior to those obtained with nonsurgical management. The objective of this report was to describe a case of nonsurgical treatment for ACL rupture followed by a contralateral rupture. A 28-year-old female practitioner of muay-thai and handball suffered a non-contact ACL rupture in the left knee, and three months after the end of rehabilitation, the patient suffered a second non-contact ACL rupture in the contralateral knee and also received nonsurgical treatment. After both ruptures the patient received a treatment program focused on the strengthening of the quadriceps and hamstring muscles, trunk stabilization, plyometrics exercises, perturbation training, and return-to-sport training. After the treatments the patient exhibited absence of pain; normal muscular function and knee extension and flexion strength; normal range of motion; normal hop tests (<10% difference between members); improvement in the knee functional capacity and total return to normal activities. After two years of follow-up, the patient remained pain free and with normal knee function. The findings demonstrate the physical therapy effects in the nonsurgical treatment of bilateral ACL rupture. The patient could return to sport practice without instability.Physical therapy in the conservative treatment for anterior cruciate ligament rupture followed by contralateral rupture: case report Further studies with a larger sample are needed to assess the recovery capacity and the full return to sport activities of patients with ACL injury.Keywords | Physical Therapy Specialty; Knee; Anterior Cruciate Ligament.RESUMO | A reconstrução cirúrgica é a indicação mais frequente no tratamento da lesão do ligamento cruzado anterior (LCA). No entanto, não existe consenso de que seus resultados sejam superiores ao tratamento não cirúr-gico. Dessa forma, o objetivo deste estudo foi descrever o efeito do tratamento conservador com fisioterapia em um caso de lesão bilateral do LCA em momentos diferentes. Mulher, 28 anos de idade, praticante de muay-thai e handebol, inicialmente sofreu lesão do LCA do joelho esquerdo e três meses depois da alta fisioterapêutica sofreu lesão do LCA contralateral. Nas duas lesões a paciente foi tratada conservadoramente com fisioterapia, com foco no fortalecimento de quadríceps e isquiotibiais, estabilização do tronco, pliometria, treino sensório-motor e, no final, treino de retorno ao esporte. Após os tratamentos, a paciente apresentou ausência de dor, função muscular e amplitude de movimento dos joelhos normais, ausência de instabilidade, testes de salto dentro da normalidade (diferença <10% entre os membros), melhora na função do joelho

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“…In addition, some studies conclude that high-demand patients such as athletes should be treated operatively more actively than non-athletes [30,31]. However, none of the current ACL treatment methods, whether operative or conservative, has been able to prevent subsequent degenerative changes in the knee joint [32].…”

Section: Introductionmentioning

confidence: 99%

Double-bundle Anterior Cruciate Ligament reconstruction: a review of literature

Suomalainen

Kannus

Järvelä³

2012

International Orthopaedics (SICOT)

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Purpose Anterior cruciate ligament (ACL) reconstruction has been under intensive discussion and debate, although the anatomy of this ligament was resolved thoroughly almost 200 years ago. The ACL consist of two bundles, anteromedial (AM) and posterolateral (PL). The conventional single-bundle method reconstructs the AM bundle only, while the modern double-bundle technique recreates both bundles for their anatomical sites. Methods An English language literature search was undertaken over the years 2000-2012 for ACL reconstruction, double-bundle versus single bundle technique. The search found 14 RCTs and two meta-analyses published to date. Results Two of the 14 studies (14 %) showed no difference between the two reconstruction methods while the remaining majority (12 trials, 86 %) concluded that the DB technique was better than the SB method. After the DB reconstruction, rotational stability of the knee was better in seven studies (50 %) and anteroposterior stability in six (43 %). No study spoke for the single-bundle technique. In addition, with the double-bundle technique knee scores were reported to be better in five (36 %) studies, and three trials (21 %) revealed less reoperations in the double-bundle group. Conclusions The double-bundle ACL reconstruction technique was reported to have better or at least the same results as the conventional single-bundle method-even at a fiveyear follow-up. However, the majority of these studies had a rather short follow-up, and thus, longer studies are needed to confirm the true long-term results of ACL surgery. Long follow-up periods are also needed to find out whether double-bundle ACL reconstruction can eventually prevent knee osteoarthritis.

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Anterior cruciate ligament tears: conservative or surgical treatment? A critical review of the literature

Abstract: Systematic review of Level I, II, III and IV studies, Level IV.

Cited by 126 publications

References 111 publications

Anterior cruciate ligament deterioration correlates with patella osteoarthritis

Anterior cruciate ligament deterioration correlates with patella osteoarthritis

Physical therapy in the conservative treatment for anterior cruciate ligament rupture followed by contralateral rupture: case report

Double-bundle Anterior Cruciate Ligament reconstruction: a review of literature

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