3.8 Article

Is it worth to perform initial non-operative treatment for patients with acute ACL injury?: a prospective cohort prognostic study

Journal

KNEE SURGERY & RELATED RESEARCH
Volume 33, Issue 1, Pages -

Publisher

SPRINGERNATURE
DOI: 10.1186/s43019-021-00094-3

Keywords

Non-operative treatment; Time of starting treatment; Acute injury; ACL; Knee

Funding

  1. Korea Health Technology R&D project through the Korea Health Industry Development Institute (KHIDI)
  2. Ministry of Health and Welfare, Republic of Korea [HI14C3484]

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The study evaluated the outcomes of implementing initial non-operative treatment for acute ACL injuries, finding that starting non-operative treatment early can lead to better clinical results. The recommendation is to initiate non-operative treatment sooner for better patient outcomes.
Purpose To evaluate the result of implementing an initial non-operative treatment program for an acute ACL injury and to find if the timing of initiating the non-operative treatment is significant. Methods This study included a prospective cohort of 85 consecutive patients with acute ACL injury who were treated according to the above strategy for the initial 3 months with 1-year follow-up. Clinical evaluations were made by Lysholm score, Tegner activity score, Lachman test (LT), pivot-shit test (PST), and the side to side difference (SSD) by KT-2000 arthrometer. The results were analyzed according to the timing of initiating the non-operative treatment. Results Initially, 84% of the patients showed LT and PST <= grade 1, and 16% with >= grade 2. At 1-year follow-up, 77 patients (91%) with LT and PST <= grade 1 did not receive reconstruction as copers and 8 patients with LT or PST >= grade 2 required reconstruction (six patients received the operation and two refused). The patients with LT and PST <= grade 1 showed average Lysholm score 91.2, average SSD 2.5 mm, and mean Tegner score decreased from 6.9 (pre-injury) to 6.2. Patients who started the non-operative treatment within 2 weeks after injury revealed superior rates of grade 0 or 1 instability than those who commenced the treatment later than 2 weeks after injury (P = 0.043). Conclusions Implementing a non-operative treatment with brace in acute phase of ACL injury appears to be an effective and viable option to achieve a reasonable clinical outcome. We recommend earlier initiation of the non-operative treatment to obtain a better result in patients with acute ACL injury.

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