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

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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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Acknowledgements

The authors thank PD Dr. Robert Csapo for his statistical support as well as for his help in the preparation of the final manuscript. The authors also thank Dr. Caroline Hepperger for her help with the final manuscript.

Funding

There is no funding source.

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Authors and Affiliations

  1. Gelenkpunkt-Sports and Joint Surgery, Olympiastraße 39, 6020, Innsbruck, Austria

    Peter Gföller, Elisabeth Abermann, Armin Runer, Christian Hoser & Christian Fink

  2. Department for Trauma Surgery and Sports Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Armin Runer

  3. Research Unit of Orthopaedic Sports Medicine and Injury Prevention, ISAG/UMIT, Eduard Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria

    Christian Hoser & Christian Fink

  4. Klinikum Schallerbacherhof, Schallerbacherhofstraße 1, 4701, Bad Schallerbach, Austria

    Mario Pflüglmayer

  5. Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, 5020, Salzburg, Austria

    Guido Wierer

Authors
  1. Peter Gföller
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  2. Elisabeth Abermann
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  3. Armin Runer
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  4. Christian Hoser
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  5. Mario Pflüglmayer
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  6. Guido Wierer
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  7. Christian Fink
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Corresponding author

Correspondence to Armin Runer.

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Conflict of interest

Christan Fink receives royalties from Karl Storz and consultancies from Karl Storz, Medacta and Zimmer BioMed. All other authors declare that they have no conflict of interest.

Ethical approval

The IRB approval for this study was waived by the ethics committee of the Medical University of Innsbruck.

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Gföller, P., Abermann, E., Runer, A. et al. Non-operative treatment of ACL injury is associated with opposing subjective and objective outcomes over 20 years of follow-up. Knee Surg Sports Traumatol Arthrosc 27, 2665–2671 (2019). https://doi.org/10.1007/s00167-018-5296-5

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  • DOI: https://doi.org/10.1007/s00167-018-5296-5

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