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Long-term outcome of anterior cruciate ligament tear without reconstruction: a longitudinal prospective study

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Abstract

Purpose

To analyse subjective and objective long-term outcomes of patients with anterior cruciate ligament (ACL)-deficient knees and limited demands regarding sportive activities. This subgroup of patients might be well-treated without ligament reconstruction.

Methods

We included 303 patients with unilateral tears of the ACL and conservative treatment into a prospective study. Mean age at injury was 33.8 (min. 18, max. 66) years. Follow-up was 27.1 (min. 21.3, max. 31.5) years. Follow-up examinations were conducted 12 and 27 years after injury. At the last follow-up we analysed 50 patients completely. To evaluate clinical and radiological outcomes we used the Lysholm score, Tegner activity scale, visual analogue scale for pain (VAS-pain), KOOS and Sherman score.

Results

Subjective outcome (Lysholm score and VAS-pain scale) improved between the 12th and 27th year after anterior cruciate ligament tear. At the same time activity level (Tegner activity scale) decreased. Also, arthritis (Sherman score) worsened over time. Twenty-seven years after injury, 90 % of the patients rated their ACL-deficient knee as normal or almost normal; 10 % of the patients rated it as abnormal. The findings of this study show that there is a subgroup of patients with ACL tears who are well treated with physiotherapy alone, not reconstructing the ligament. Also, other authors found this correlation between activity level reduction and better subjective outcome.

Conclusions

Conservative treatment of an ACL tear is a good treatment option for patients with limited demands regarding activity. Patient age, sportive activities and foremost subjective instability symptoms in daily life should be considered when deciding for or against ACL reconstruction.

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References

  1. Matic A, Petrovic Savic S, Ristic B, Stevanovic VB, Devedzic G (2016) Infrared assessment of knee instability in ACL deficient patients. Int Orthop 40:385–391

    Article  PubMed  Google Scholar 

  2. Shabani B, Bytyqi D, Lustig S, Cheze L, Bytyqi C, Neyret P (2015) Gait knee kinematics after ACL reconstruction: 3D assessment. Int Orthop 39:1187–1193

    Article  PubMed  Google Scholar 

  3. Barenius B, Ponzer S, Shalabi A, Bujak R, Norlén L, Eriksson K (2014) Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial. Am J Sports Med 42:1049–1057

    Article  PubMed  Google Scholar 

  4. Tsoukas D, Rotopoulos V, Basdekis G, Makridis KG (2016) No difference in osteoarthritis after surgical and non-surgical treatment of ACL-injured knees after 10 years. Knee Surg Sports Traumatol Arthrosc 24:2953-2959

  5. Ambra LF, Rezende FC, Xavier B, Shumaker FC, da Silveira Franciozi CE, Luzo MV (2016) Anterior cruciate ligament reconstruction: how do we perform it? Brazilian orthopaedic surgeons’ preference. Int Orthop 40:595–600

    Article  PubMed  Google Scholar 

  6. Filardo G, Kon E, Tentoni F, Andriolo L, Di Martino A, Busacca M, Di Matteo B, Marcacci M (2016) Anterior cruciate ligament injury: post-traumatic bone marrow oedema correlates with long-term prognosis. Int Orthop 40:183–190

    Article  PubMed  Google Scholar 

  7. Risberg MA, Oiestad BE, Gunderson R, Aune AK, Engebretsen L, Culvenor A, Holm I (2016) Changes in knee osteoarthritis, symptoms, and function after anterior cruciate ligament reconstruction: a 20-year prospective follow-up study. Am J Sports Med 44:1215–1244

    Article  PubMed  Google Scholar 

  8. Meuffels DE, Favejee MM, Vissers MM, Heijboer MP, Reijman M, Verhaar JAN (2009) Ten year follow-up study comparing conservative versus operative treatment of anterior cruciate ligament ruptures. A matched-pair analysis of high level athletes. Br J Sports Med 43:347–351

    Article  CAS  PubMed  Google Scholar 

  9. Streich NA, Zimmermann D, Bode G, Schmitt H (2011) Reconstructive versus non-reconstructive treatment of anterior cruciate ligament insufficiency. A retrospective matched-pair long-term follow-up. Int Orthop 35:607–613

    Article  PubMed  Google Scholar 

  10. Ramski DE, Kanj WW, Franklin CC, Baldwin KD, Ganley T (2013) Anterior cruciate ligament tears in children and adolescents: a meta-analysis of nonoperative versus operative treatment. Am J Sports Med 42:2769–2776

    Article  PubMed  Google Scholar 

  11. Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154

    Article  CAS  PubMed  Google Scholar 

  12. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    Google Scholar 

  13. Price D, Bush F, Long S, Harkins S (1994) A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain 56:217–226

    Article  CAS  PubMed  Google Scholar 

  14. Roos EM, Lohmander LS (2003) The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 1:64

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sherman MF, Warren RF, Marshall JL, Savatsky GJ (1988) A clinical and radiographical analysis of 127 anterior cruciate insufficient knees. Clin Orthop Relat Res 227:22–237

    Google Scholar 

  16. Sherman MF, Lieber L, Bonamo JR, Podesta L, Reiter I (1991) The long-term followup of primary anterior cruciate ligament repair. Defining a rationale for augmentation. Am J Sports Med 19:243–255

    Article  CAS  PubMed  Google Scholar 

  17. Fink C, Hoser C, Hackl W, Navarro RA, Benedetto KP (2001) Long-term outcome of operative or nonoperative treatment of anterior cruciate ligament rupture—is sports activity a determining variable? Int J Sports Med 22:304–309

    Article  CAS  PubMed  Google Scholar 

  18. Delince P, Ghafil D (2012) Anterior cruciate ligament tears: conservative or surgical treatment? A critical review of the literature. Knee Surg Sports Traumatol Arthrosc 20:48–61

    Article  PubMed  Google Scholar 

  19. Filbay SR, Culvenor AG, Ackerman IN, Russel TG, Crossley KM (2015) Quality of life in anterior cruciate ligament-deficient individuals: a systematic review and meta-analysis. Br J Sports Med 49:1033–1041

    Article  CAS  PubMed  Google Scholar 

  20. Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS (2010) A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med 363:331–342

    Article  CAS  PubMed  Google Scholar 

  21. Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam JR, Lohmander LS (2013) Treatment for acute anterior cruciate ligament tear: five year outcome of randomized trial. BMJ 346:f232

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kannus P, Jarvinen M (1987) Conservatively treated tears of the anterior cruciate ligament. Long-term results. J Bone Joint Surg Am 69:1007–1012

    CAS  PubMed  Google Scholar 

  23. Barrack RL, Bruckner JD, Kneisl J, Inman WS, Alexander AH (1990) The outcome of nonoperatively treated complete tears of the anterior cruciate ligament in active young adults. Clin Orthop Relat Res 259:192–199

    Google Scholar 

  24. Engstrom B, Gornitzka J, Johansson C, Wredmark T (1993) Knee function after anterior cruciate ligament ruptures treated conservatively. Int Orthop 17:208–213

    Article  CAS  PubMed  Google Scholar 

  25. Spahn G, Schiltenwolf M, Harmann B, Grifka J, Hofmann GO, Klemm HT (2015) The time-related risk for knee osteoarthritis after ACL injury: results from a systematic review. Orthopade 45:81–90

    Article  Google Scholar 

  26. Chalmers PN, Mall NA, Moric M, Sherman SL, Paletta GP, Cole BJ, Bach BR Jr (2014) Does ACL reconstruction alter natural history?: A systematic literature review of long-term outcomes. J Bone Joint Surg Am 96:292–300

    Article  PubMed  Google Scholar 

  27. Luc B, Gribble PA, Pietrosimone BG (2014) Osteoarthritis prevalence following anterior cruciate ligament reconstruction: a systematic review and numbers-needed-to-treat analysis. J Athl Train 49:806–819

    Article  PubMed  PubMed Central  Google Scholar 

  28. Smith TO, Postle K, Penny F, McNamara I, Mann CJ (2014) Is reconstruction the best management stategy for anterior cruciate ligament rupture? A systematic review and meta-analysis comparing anterior cruciate ligament reconstruction versus non-operative treatment. Knee 21:462–470

    Article  CAS  PubMed  Google Scholar 

  29. Harris KP, Driban JB, Sitler MR, Cattano NM, Balasubramanian E (2015) Tibiofemoral osteoarthritis after surgical or nonsurgical treatment of anterior cruciate ligament rupture: a systematic review. J Athl Train. doi:10.4085/1062-6050-49.3.89

  30. Fithian CD, Paxton EW, Stone ML, Luetzow WF, Csintalan RP, Phelan D, Daniel DM (2005) Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. Am J Sports Med 33:335–346

    Article  PubMed  Google Scholar 

  31. Kessler MA, Behrend H, Henz S, Stutz G, Rukavina A, Kuster MS (2008) Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment. Knee Surg Sports Traumatol Arthrosc 16:442–448

    Article  CAS  PubMed  Google Scholar 

  32. Gille J, Gerlach IJ, Oheim R, Hintze T, Himpe B, Schultz AP (2015) Functional outcome of septic arthritis after anterior cruciate ligament surgery. Int Orthop 39:1195–1201

    Article  PubMed  Google Scholar 

  33. Sanders TL, Kremers HM, Bryan AJ, Kremers WK, Levy BA, Dahm DL, Stuart MJ, Krych AJ (2016) Incidence of and factors associated with the decision to undergo anterior cruciate ligament reconstruction 1 to 10 years after injury. Am J Sports Med 44:1558–1564

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr. 11, 97074, Wuerzburg, Germany

    Christian Konrads, Stephan Reppenhagen, Daniel Belder, Sascha Goebel, Maximilian Rudert & Thomas Barthel

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  1. Christian Konrads
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  2. Stephan Reppenhagen
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  3. Daniel Belder
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  4. Sascha Goebel
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  6. Thomas Barthel
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Correspondence to Christian Konrads.

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Konrads, C., Reppenhagen, S., Belder, D. et al. Long-term outcome of anterior cruciate ligament tear without reconstruction: a longitudinal prospective study. International Orthopaedics (SICOT) 40, 2325–2330 (2016). https://doi.org/10.1007/s00264-016-3294-0

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  • DOI: https://doi.org/10.1007/s00264-016-3294-0

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