Not Every ACL Tear Needs Early Surgery, Study Suggests

One expert says treatment of the common knee injury is best decided case-by-case

By Steven Reinberg
HealthDay Reporter

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WEDNESDAY, July 21 (HealthDay News) -- Tears to the anterior cruciate ligament (ACL) of the knee are a relatively common and debilitating sports injury, typically leading to surgical repair.

But a new study in the July 22 issue of the New England Journal of Medicine suggests that some patients may have options beyond immediate reconstructive surgery.

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"ACL reconstruction, in addition to supervised rehabilitation, is not necessary for all non-professional athletes to achieve similar self-reported function and quality of life," concluded study co-author Ewa Roos, professor and head of the Research Unit for Musculoskeletal Function and Physiotherapy at the University of Southern Denmark, Odense.

"However, at least five-year follow-up is necessary to know if any of the [alternative treatment] strategies is associated with less structural damage," Roos added.

The ACL is a ligament vital to the stability of the knee. An injury or tear to this ligament can cause pain and cause the knee to give way under even normal activity. These injuries most often occur in sports that place the ACL under high stress, the researchers explained.

For the study, the Danish team randomly assigned 121 active, young adults with ACL injuries to rehabilitation plus early ACL reconstructive surgery, or rehabilitation with surgery conducted later on -- if needed.

Among the 59 patients assigned to rehabilitation, 23 ended up having the surgery later on, while the other 36 did not, the study authors said.

In terms of pain, function and "knee-related quality of life," the researchers found no differences at two years post-injury between those who underwent early knee reconstruction, those who had rehabilitation plus delayed reconstruction, or those who underwent rehabilitation only, Roos said.

"A strategy of initial supervised rehabilitation-only was associated with a reduction of the surgery rate by 60 percent," Roos said. "This has monetary implications since the direct costs for ACL reconstructions are estimated to [be] $3 billion [annually] in the U.S. alone," she said.

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