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. 2019 Aug;27(8):2665-2671.
doi: 10.1007/s00167-018-5296-5. Epub 2018 Nov 22.

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

Peter Gföller  1 , Elisabeth Abermann  1 , Armin Runer  2   3 , Christian Hoser  1   4 , Mario Pflüglmayer  5 , Guido Wierer  6 , Christian Fink  1   4
Affiliations

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

Peter Gföller et al. Knee Surg Sports Traumatol Arthrosc. 2019 Aug.

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.

Keywords: ACL injury; Conservative treatment; Objective clinical outcome; Radiological outcome; Subjective outcome.

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