ACL injuries may not always require immediate surgery, study finds


February 1, 2013

Topic: orthopaedic surgeons

ACL injuries may not always require immediate surgery, study finds

When an athlete experiences a ligament tear in their knee, surgery right away is often prescribed by orthopaedic surgeons as the best way to rectify the injury. However, this may not always be the case. In 2010, Swedish researchers from Lund University published orthopaedic research in the New England Journal of Medicine that found that 60 percent of anterior cruciate ligament (ACL) injuries did not require surgical reconstruction, and instead could be rehabilitated with physical therapy to full recovery. Despite the mixed reception to their results, they have now released a follow-up study that can be read in the British Medical Journal that confirms the previous findings.

No difference among treatment arms
After studying more than 120 patients who had ACL injuries and were treated with rehabilitation, the study's investigators found that there was no substantial difference in outcome among those who were operated on immediately, those who had the surgery later on and individuals who opted for non-surgical interventions. In addition, they discovered that putting off surgery or refraining from it did not increase a person's chances of developing osteoarthritis or other orthopaedic problems.

"On an international front, almost all of those with ACL injuries are operated on. In Sweden, just over half are operated on, but in southern Sweden we have been working for many years to use advanced rehabilitation training as the first method of treatment. Our research so far has confirmed that we are right in not choosing to operate on these injuries immediately. Longer-term follow-up is important, however, if we are to look more closely at the development of osteoarthritis in particular," said researcher Richard Frobell.

ACL injuries are prevalent in the U.S.
The American Society of Orthopaedic Surgeons estimates that, in the U.S., approximately 200,000 ACL injuries occur and 100,000 reconstructions are performed every year. The injury is seen most often in athletes who participate in sports such as basketball, football, skiing and soccer.

Ultimately, patients should talk to their doctors about what treatment is the best for them. For instance, individual factors - such as what a person's physical activities are and the overall health of the knee - should be taken into consideration when deciding whether to undergo surgery or try to recover through physical therapy alone, The Huffington Post reported. 


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