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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-08-2019 | KNEE

Non-operative treatment of ACL injury is associated with opposing subjective and objective outcomes over 20 years of follow-up

Authors: Peter Gföller, Elisabeth Abermann, Armin Runer, Christian Hoser, Mario Pflüglmayer, Guido Wierer, Christian Fink

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2019

Abstract

Purpose

The aim of this study was the evaluation of long-term clinical and radiological outcomes of non-operative treatment of anterior cruciate ligament (ACL) deficiency. The hypothesis was that conservative treatment would be associated with a deterioration of subjective and objective measures of joint health and disability over time.

Methods

From an initial sample of 41 patients conservatively treated for ACL rupture, 10 received secondary ACL reconstruction, 1 was excluded due to contralateral ACL injury, and 1 patient required total knee replacement and a high tibial osteotomy. Seven further patients were lost to follow-up. The remaining 21 patients (15 male, 6 female, mean age 53.1 ± 9.2 years at the last follow-up) were evaluated by the same two examiners 5–7, 10–13 and 20–22 years after the injury. The evaluation was based on objective and subjective scores, instrumented testing, radiographic examination and assessment of sports activity.

Results

While subjective patient satisfaction improved over time, objective scores stayed constant or deteriorated (radiologic evaluation). Instrumented knee laxity testing showed an initial tendency to increasing instability, followed by a decrease in anterior tibial translation in the second half of the observation period. Physical activity levels, particularly in high-risk sports, decreased significantly (p < 0.05) compared to preinjury levels. All patients developed significant arthritic degenerative changes over time compared to the uninjured contralateral knee. No correlation to activities in high- or low-risk pivoting sports was found.

Conclusions

Patient satisfaction with conservative treatment of ACL injuries is good in spite of objective measures indicating increasing degenerative changes.

Level of evidence

IV.

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Title: Non-operative treatment of ACL injury is associated with opposing subjective and objective outcomes over 20 years of follow-up
Authors: Peter Gföller
Elisabeth Abermann
Armin Runer
Christian Hoser
Mario Pflüglmayer
Guido Wierer
Christian Fink
Publication date: 01-08-2019
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-018-5296-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Non-operative treatment of ACL injury is associated with opposing subjective and objective outcomes over 20 years of follow-up

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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