Frobell, R., Roos, H., Roos, E., Roemer, F., Ranstam, J. and Lohmander, S. British Medical Journal; 2013; 346, 1 – 12.
http://www.bmj.com/content/346/bmj.f232
No consensus exists in the literature in
regards to ACL rupture treatment. Generally held opinion advocates ACL
reconstruction as a first – line treatment approach in young active adults.
Reason for that is to prevent further damage to the menisci and cartilage and
in result early OA onset. On the other hand, no evidence is present to support
that notion. In addition, more research findings prove that ACL reconstruction
is no better treatment than rehabilitation in regards to early OA development.
Lack high quality research is present though. To fill that gap, authors
conducted this randomised trial to compare the mid-term (five year) patient
reported and radiographic outcomes between those treated with rehabilitation
plus early ACL reconstruction and those treated with rehabilitation and
optional delayed ACL reconstruction.
No statistically significant differences
were found in regards to KOOS, any of the five individual subscales of KOOS,
SF-36, Tegner activity scale, radiographic osteoarthritis, or meniscus surgery
between the two treatment strategies at five years follow – up. Knee stability measured
with the Lachman test and Pivot – Shift test at rest at five years was
statistically significantly better in knees assigned to early anterior cruciate
ligament reconstruction.The results of this study indicate that ACL surgical reconstruction might not protect the injured knee from developing structural changes consistent with osteoarthritis. Generally held opinion that lack or delayed ACL reconstruction may lead to meniscus tear has not been supported by the findings of the current study. Authors concluded that in young, active adults with an ACL rupture, a strategy of early reconstruction plus rehabilitation did not provide better results than a strategy of initial rehabilitation with the option of having a later ACL repair. More long – term research findings are needed to obtain consensus.
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