02/10/2019
Repost Fantastic post from recently about ACL repair ๐ check them out if you're not already! Also check out .nicolept recent Post too on this topic! ๐ ๐ ๐ โฝ ๐ ๐ฟ ๐ ๐ธ๐น๐ธ๐น๐ธ๐น๐ธ๐น๐ธ๐น๐ธ๐น
A couple of years ago, the decision whether to operate or not after an tear was mainly based on age and activity level. To this day, patients who wish to return to their pivoting are advised to undergo surgical reconstruction ๐ (Grindem et al. 2012).
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A systematic review from ๐ Monk et al. (2016) examined the literature on the effects of surgical versus conservative interventions. The only study included, the "KANON trial" found no significant differences between surgically and conservatively managed ACL ruptures. However, patients in the conservative group had the option of delayed and some also received initial surgical intervention for concomitant injuries such as lesions. In a cohort of 50 high-level of whom 66% were players, a 20-year follow-up showed that there was no significant difference between surgical and conservative approaches in terms of developing osteoarthritis. While stability was better in those managed surgically, they did not report better subjective and objective functional outcomes and had first tried a conservative approach (van Yperen et al. 2018). ๐ ๐ธ๐น๐ธ๐น๐ธ๐น๐ธ๐น๐ธ๐น๐ธ๐น๐ธ
๐ Grindem et al. (2012) also found no significant difference in the rate of return to pivoting sports after 1 year between those managed surgically and conservatively. These same results were also seen in high-level athletes at a 10-year follow-up (Meuffels et al. 2009). ๐ ๐ธ๐น๐ธ๐น๐ธ๐น๐ธ๐น๐ธ๐น๐ธ
results after ACL injury are moderate to good, but not excellent. While the return-to-sport numbers are the same in both treatment pathways, a lot of individuals will not reach their pre-injury level. It is of upmost importance that you communicate this to your patient when they ask which route to go.