Elsevier

The Knee

Volume 8, Issue 1, March 2001, Pages 5-11
The Knee

Long-term results of non-operative treatment of anterior cruciate ligament injury

https://doi.org/10.1016/S0968-0160(00)00062-4Get rights and content

Abstract

We retrospectively reviewed the record of 89 patients with complete anterior cruciate ligament injury, documented by arthroscopic examination to investigate the long-term results in relation to the generation of osteoarthritis. The mean age of the patients was 34.9 years at follow-up and the mean duration of follow-up was 12.0 years. The mean Lysholm score was 89 points at follow-up. The mean Tegner activity score was 5.7 points before injury and 4.5 points at follow-up. Plain radiographs revealed 63% of osteoarthritis and 37% of which had joint space narrowing. The age of the patients, the level of sports activity, the history of meniscectomy, obesity and the osteoarthritis of the contralateral knee were found to be significant risk factors in osteoarthritis after anterior cruciate ligament injury. The most influential factor for osteoarthritis was considered meniscectomy, in combination with the risk factors of primary osteoarthritis. It should also be noted that modification of sports activity level was the most important factor for avoiding the combined injury of meniscus and osteoarthritis.

Introduction

Many studies have suggested that the outcome of a ruptured anterior cruciate ligament in the majority of active young patients who attempt to remain active follows a predictable course of progressive deterioration of the knee joint [1], [6], [8], [9], [20], [21]. Reconstruction is widely advocated for the young active individual. This recommendation is based on the high incidence of secondary meniscus injury and early development of osteoarthritis. Non-operative management was recommended to the patients who had low athletic demands or sedentary occupations [2], [4], [5], and meniscectomy was performed for meniscal injury without ligament reconstruction [11], [19], [22]. The long-standing anterior cruciate ligament deficient knee, especially with meniscectomy, leads to a high percentage of osteoarthritis [3], [8], [23], [24], [25], [27], in combination with the risk factors of primary osteoarthritis. We performed a retrospective study to evaluate the long-term results after non-operative treatment of a rupture of the anterior cruciate ligament and to investigate the factors for osteoarthritis.

Section snippets

Materials and methods

One hundred and seven patients who had an isolated anterior cruciate ligament insufficiency were diagnosed arthroscopically. Non-operative management was selected for the patients more than 40 years old and the patients who were not willing to have ACL reconstruction and agreed to quit or decrease their sports activity. All patients were diagnosed arthroscopically and received instructions on the nature of the injury, the need for modification of athletic activity, and the importance of lower

Subjective symptoms (89 patients)

The mean Lysholm score was 89.0 points (range, 48–100 points) at the time of follow-up. Thirty-five patients (39%) had a score of more than 94 points (excellent), 36 patients (40%) between 84 and 94 points (good), and 18 patients (21%) less than 84 points (fair). Pain and giving way of the knee were the most common symptoms. Thirty-five patients (39%) had no pain, 51 patients (57%) noted slight, intermittent pain after strenuous exercise, and three patients had marked pain during severe

Factors for osteoarthritis

Seventy patients of the original group were divided into two subgroups; the OA group, which was composed of 44 patients with osteoarthritis on the follow-up radiographs, and the non-OA group, which was composed of 26 patients without osteoarthritis. The following factors were compared between the OA group and the non-OA group (Table 1).

Discussion

Several authors have reported that non-operative management of a rapture of the anterior cruciate ligament with coordinated rehabilitation and modification of activity resulted in satisfactory knee function [4], [10]. Others have been convinced that an operation is necessary to avoid progressively worse knee function [1], [9], [20], [21]. McDaniel reported that half of their patients were able to return to the preinjury sports level and 30% of the patients had osteoarthritis, which was related

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