Four to ten year followup of unreconstructed anterior cruciate ligament tears

Abstract

Both operative and nonoperative methods have been advocated for the treatment of ACL tears. However, the optimum management of this injury remains controversial. In the present study, patients treated nonoperatively were evaluated retrospectively 4 to 10 years after ACL tears were documented by arthroscopy and by mild to moderate pivot shifts under anesthesia. Forty-nine patients who underwent arthroscopic evaluation of the knee between 1976 and 1982 were found to have complete tears of the ACL. A mild to moderate pivot shift was present under anesthesia. One or both menisci were torn in two-thirds of the knees, requiring partial meniscectomies. The average age of the patients was 27 years (range, 16 to 46 years). Because of persistent disabling instability, 9 patients (18%) underwent late ACL reconstruction. The remaining 40 patients were evaluated at an average of 5.6 years after documentation of the tear (range, 4 to 10 years). At followup, 25 (62%) of the 40 patients had satisfactory subjective results. Eight of the patients (20%) had returned to their preinjury level of athletic activities without restrictions, and 10 (25%) functioned at the same level but with symptoms, some patients requiring bracing. Seventeen patients (43%) had diminished their level of sports activities, while 5 patients (12%) had given up all sports. Only 2 patients required late meniscectomies. On physical examination, 27 patients (87%) had pivot shifts. Instrumented laxity testing revealed an injured to normal difference of 3.1 mm with a 20 pound force. Radiographic studies were interpreted as normal in 35% of the knees, whereas 65% demonstrated mild degenerative changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Elucidation of a potentially destabilizing control strategy in ACL deficient non-copers

“…Most active individuals with a ruptured anterior cruciate ligament (ACL) experience knee instability and difficulty participating in physical activity (non-copers) [1,9,21,27]. Complex neuromuscular control strategies appear to be responsible for the ability of some individuals to dynamically stabilize their knees and return to high-level activities without surgery (copers) [6].…”

Medium-Term Course of Clinical Function and Progression of Osteoarthritis after Primary Reconstruction of Anterior Cruciate Ligament: 5- to 8-Year Results

“…Progressive osteoarthritis is reported with conservative treatment of ACL ruptures [30,31], with revision ACL reconstruction [32,33], in knees with chronically insufficient ACL [4,25,34], or after partial or complete meniscus resection [7,35,36]. With primary ACL reconstruction, radiographic signs of progressive osteoarthritis are reported in up to 25% [7,16,25].…”

Non-Operative Management of Anterior Cruciate Ligament Injuries in the General Population

“…For obvious ethical and economical reasons, it was impossible to conduct second-look arthroscopic or MRI examinations to provide more rigorous data on secondary meniscal lesions. Most of the recent papers on ACL lesions deal mainly with athletic or high-demand patient populations, and many focus on the poor results of conservative treatments in this population, with their high incidence of secondary injuries (Noyes et al 1983a;Finsterbush et al 1990), degenerative changes (Fetto and Marshall 1980;Kannus and Järvinen 1987;Pattee et al 1989), cessation of sport activities (Andersson et al 1989;Sommerlath, Lysholm and Gillquist 1991) and on the need for secondary joint stabilisation (Noyes et al 1983b;Barrack et al 1990). These reports led to the concept that only surgical reconstruction could allow unrestricted return to sport and prevent secondary problems (Daniel and Fithian 1994).…”