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

Abstract

The operative treatment of lesions of the anterior cruciate ligament (ACL) in athletes has been widely advocated and performed. We have investigated the outcome of non-operative management in a lowerdemand, general population. We reviewed a consecutive group of 228 patients, which excluded professional and high-level athletes, for two to 12 years after an ACL lesion had been diagnosed by arthroscopy.There was a low incidence of secondary ACL and meniscal surgery, 5.4% and 3.5% respectively, and all these procedures were performed during the first three years after the ACL injury.We studied a subgroup of 109 patients with follow-up of at least five years (mean 8.5 years) and evaluated them using the IKDC score. The general outcome was reasonably satisfactory, with 23% in grade A, 50% in grade B, 21% in grade C and only 6.4% in grade D. We found no statistically significant prognostic effect within this group as regards age, activity levels, or the incidence of associated lesions.J Bone Joint Surg [Br] ] 1996;78-B:446-51. Received 25 August 1995; Accepted after revision 29 November 1995Lesions of the anterior cruciate ligament (ACL) in athletes have been studied extensively in orthopaedic sports medicine, and operative treatment using grafts is widely advocated for this particular group of patients (Fetto and Marshall 1980;Noyes et al 1983a;Kannus and Järvinen 1987;Andersson et al 1989;Barrack et al 1990;Daniel and Fithian 1994). Many ACL lesions, however, are seen in nonathletes as a result of accidents or low-grade recreational activities (Jain, Swanson and Murdoch 1983;Casteleyn, Handelberg and Opdecam 1988). We aimed to investigate the outcome of the conservative treatment of ACL lesions in a lower-demand population. PATIENTS AND METHODSOver a period of 12 years, we managed a total of 274 patients with acute traumatic knee haemarthrosis. All had examination under anaesthesia and arthroscopy.Of these, we treated 46 by ACL reconstruction. They included patients with gross or multidirectional joint laxity (grade-3 or grade-4 pivot shift, combined lesions of the ACL and lateral collateral ligament (LCL) or posterior cruciate ligament (PCL)) and in addition all high-level or professional athletes. These 46 cases (16.8%) were excluded from the study group.This left a consecutive group of 228 patients (83%) who were managed conservatively. There was an almost fourfold male to female ratio and the mean age at the time of injury was 33.2 years (16 to 66). The main causes of injury were daily living activities (28.1%), traffic accidents (11.8%), and recreational activities (60.1%) ( Table I). Initial management. In 83% of the cases, arthroscopic evaluation was within three weeks of the index injury. The proportions of isolated ACL ruptures and those associated with meniscal and ligamentous lesions were comparable with those reported in previous studies (Casteleyn et al 1988) (Tables I and II); only 21 of the ACL tears (9%) were partial. Intrasynovial ACL lesions (14; 6.1%) were left as much as possible within the synov...

Ways of Experiencing Participation and Factors Affecting the Activity Level After Nonreconstructed Anterior Cruciate Ligament Injury: A Qualitative Study

“…Even though there were different demand levels, unrestricted participation was also present in highly demanding activities. Considering the risk of further injury and the risk of developing OA, 5,19,24,32 some caution may be warranted regarding returning to highly demanding activities. Unconditioned participation and participation as conditioned by experiencing control of the knee, when instability is not present or actions have been taken to control instability, may limit the risk.…”

“…Informing patients that it may take some time to recover and advice to modify activity, especially during the first years, seem important for a good outcome. 5,13 Future studies need to investigate a more precise time frame for regaining the physical function and factors affecting the progression toward an acceptable and satisfactory activity level.…”

“…11,25,27 The status of the knee is the most commonly reported reason for a decrease in activity level. 5,23,31 Advice from surgeons, change of lifestyle, 4,7 loss of interest, increased age, and lack of time or facilities are other reported reasons. 3 Hence, the assessment of a successful outcome after an ACL injury with return to the preinjury activity level may not always be optimal.…”

“…37 The extent of the impact of the injury on activity participation varies; some experience instability in daily living, while others are able to return to preinjury activity levels without reconstruction of the torn ligament. 3,5,7,13,25,31 Some can even return to pivoting sports, 4,9 but not always without symptoms and occasional episodes of instability. 23,28,29 Movement patterns, self-reported knee function, the leg symmetry index in single-leg hop tests, and quadriceps strength are factors found to differentiate between those who return to the preinjury activity level and those who do not.…”

Effect of 9 mm Tibial Tuberosity Advancement on Cranial Tibial Translation in the Canine Cranial Cruciate Ligament‐Deficient Stifle

“…Non-operative treatment has met with success in patients willing to restrict their athletic activity. 123,124 Increasing levels of osteoarthritis and risk of meniscal injury were reported, however. 118,123 Alternatively, some studies suggest individuals can return to high risk activity successfully without surgical stabilization.…”