Many ACL Reconstructions Could Be Avoided

Photo: Knee

ACL injuries: Rehabilitation often
helps;© Picture Disk

“In our study, patients with acute ACL injuries were randomly divided into two groups for treatment with rehabilitation plus early ACL reconstruction or rehabilitation alone with the possibility of a later operation if this was deemed necessary. After two years only 40 percent of the latter group needed to have an ACL reconstruction.

"Despite the fact that many of the patients were active sportsmen and women, we found no difference between the treatment groups in terms of knee function, activity level or well-being two years after the injury. Neither did we find any difference in these respects when we compared those who were treated with rehabilitation alone with those who had an early operation”, says Richard Frobell, researcher at Lund University.

A total of 121 patients took part in the study. The patients were aged between 18 and 35 and had an acute ACL injury in a previously healthy knee. Professional athletes and those who did not regularly practise sport were excluded from the study. All patients underwent extensive rehabilitation.

Sixty-two patients were selected at random to also undergo surgical reconstruction within four to six weeks of the injury, and 59 patients were selected at random to initially undergo treatment with rehabilitation alone. All operations were carried out in accordance with well established methods.

"There are almost 10 000 scientific publications addressing the ACL and 50 percent of these are about surgical treatment. However, none of these studies have shown that surgical reconstruction produces better results than rehabilitation alone. Despite this, we perform 3 000 cruciate ligament reconstructions a year in Sweden”, says Stefan Lohmander, professor and consultant at Lund University.

Rehabilitation with experienced physiotherapists produces the same results as operation for more than half of the individuals in this patient group and only four out of ten need an operation. The patients in the study will continue to be examined in order to find out whether the results are the same in the longer term and to see if there is any difference between treatments in terms of the risk of developing osteoarthritis in the knee.


MEDICA.de; Source: The Swedish Research Council / Lund University