The Journal of Bone and Joint Surgery, Vol 70, Issue 10 1483-1488, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc

JOURNAL CONTENTS

Acute tears of the anterior cruciate ligament. Surgical versus conservative treatment

WG Clancy, JM Ray and DJ Zoltan
University of Wisconsin, University Hospital, Section of Sports Medicine, Madison 53792.

In a prospective eight-year study comparing surgical and conservative treatment of acute tears of the anterior cruciate ligament, ninety-two patients in whom a tear had been confirmed either by arthroscopy or by arthrotomy were treated and could be followed. The choice of treatment was determined entirely by whether the result of a pivot-shift test was graded as absent, trace, or mild (non-operative treatment) or as moderate or severe (surgical treatment). Surgical treatment consisted of primary repair of the torn ligament and augmentation with a patellar tendon graft. Twenty-two patients were treated non-operatively, and the results were evaluated after twenty-four to eighty-two months (average, forty-eight months). Seventy patients were treated surgically, and fifty-two of them (approximately 70 per cent) returned for follow-up after twenty-four to 100 months (average, forty-eight months); an additional eighteen patients answered a questionnaire. In the non-operative group, about half of the results were graded as excellent or good and half, as fair or a failure. In the surgical group, all but two of the patients had an excellent or a good result; two patients had a fair result. No result was graded as a failure. The results of this study suggest that when the pivot-shift test is not strongly positive, half of the patients will do reasonably well after treatment with a non-operative program of functional rehabilitation. The patients in this study who had a more unstable knee had far better results after a repair and augmentation procedure than have been previously reported after primary repair alone.
CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				K Button, R van Deursen, P Price, E D de Bruin, and D Rosenbaum Classification of functional recovery of anterior cruciate ligament copers, non-copers, and adapters * COMMENTARY Br. J. Sports Med., October 1, 2006; 40(10): 853 - 859. [Abstract] [Full Text] [PDF]

				J. O. Drogset, T. Grontvedt, and G. Myhr Magnetic Resonance Imaging Analysis of Bioabsorbable Interference Screws Used for Fixation of Bone-Patellar Tendon-Bone Autografts in Endoscopic Reconstruction of the Anterior Cruciate Ligament Am. J. Sports Med., July 1, 2006; 34(7): 1164 - 1169. [Abstract] [Full Text] [PDF]

				J. O. Drogset, T. Grontvedt, O. R. Robak, A. Molster, A. T. Viset, and L. Engebretsen A Sixteen-Year Follow-up of Three Operative Techniques for the Treatment of Acute Ruptures of the Anterior Cruciate Ligament J. Bone Joint Surg. Am., May 1, 2006; 88(5): 944 - 952. [Abstract] [Full Text] [PDF]

				A. F. Anderson, J. J. Irrgang, M. S. Kocher, B. J. Mann, J. J. Harrast, and Members of the International Knee Documentation Co The International Knee Documentation Committee Subjective Knee Evaluation Form: Normative Data Am. J. Sports Med., January 1, 2006; 34(1): 128 - 135. [Abstract] [Full Text] [PDF]

				D. C. Fithian, E. W. Paxton, M. L. Stone, W. F. Luetzow, R. P. Csintalan, D. Phelan, and D. M. Daniel Prospective Trial of a Treatment Algorithm for the Management of the Anterior Cruciate Ligament-Injured Knee Am. J. Sports Med., March 1, 2005; 33(3): 335 - 346. [Abstract] [Full Text] [PDF]

				J. D. Yoo, R. Papannagari, S. E. Park, L. E. DeFrate, T. J. Gill, and G. Li The Effect of Anterior Cruciate Ligament Reconstruction on Knee Joint Kinematics Under Simulated Muscle Loads Am. J. Sports Med., February 1, 2005; 33(2): 240 - 246. [Abstract] [Full Text] [PDF]

				W. R. Dunn, S. Lyman, A. E. Lincoln, P. J. Amoroso, T. Wickiewicz, and R. G. Marx The Effect of Anterior Cruciate Ligament Reconstruction on the Risk of Knee Reinjury Am. J. Sports Med., December 1, 2004; 32(8): 1906 - 1914. [Abstract] [Full Text] [PDF]

				A. D. Georgoulis, A. Papadonikolakis, C. D. Papageorgiou, A. Mitsou, and N. Stergiou Three-Dimensional Tibiofemoral Kinematics of the Anterior Cruciate Ligament-Deficient and Reconstructed Knee during Walking Am. J. Sports Med., January 1, 2003; 31(1): 75 - 79. [Abstract] [Full Text] [PDF]

				W. H. Wu, T. Hackett, and J. C. Richmond Effects of Meniscal and Articular Surface Status on Knee Stability, Function, and Symptoms after Anterior Cruciate Ligament Reconstruction: A Long-term Prospective Study Am. J. Sports Med., November 1, 2002; 30(6): 845 - 850. [Abstract] [Full Text] [PDF]

				K. M. Oates, D. P. Van Eenenaam, K. Briggs, K. Homa, and W. I. Sterett Comparative Injury Rates of Uninjured, Anterior Cruciate Ligament-Deficient, and Reconstructed Knees in a Skiing Population Am. J. Sports Med., September 1, 1999; 27(5): 606 - 610. [Abstract] [Full Text] [PDF]

				K. J. Faber, J. R. Dill, A. Amendola, L. Thain, A. Spouge, and P. J. Fowler Occult Osteochondral Lesions After Anterior Cruciate Ligament Rupture: Six-Year Magnetic Resonance Imaging Follow-up Study Am. J. Sports Med., July 1, 1999; 27(4): 489 - 494. [Abstract] [Full Text] [PDF]

				C. B. FRANK and D. W. JACKSON Current Concepts Review - The Science of Reconstruction of the Anterior Cruciate Ligament J. Bone Joint Surg. Am., October 1, 1997; 79(10): 1556 - 76. [Full Text]

				F. R. Noyes and S. D. Barber-Westin A Comparison of Results in Acute and Chronic Anterior Cruciate Ligament Ruptures of Arthroscopically Assisted Autogenous Patellar Tendon Reconstruction Am. J. Sports Med., July 1, 1997; 25(4): 460 - 471. [Abstract] [PDF]

				S. D. Barber-Westin, F. R. Noyes, and M. Andrews A Rigorous Comparison Between the Sexes of Results and Complications After Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., July 1, 1997; 25(4): 514 - 526. [Abstract] [PDF]

				D. B. O'NEILL Arthroscopically Assisted Reconstruction of the Anterior Cruciate Ligament. A Prospective Randomized Analysis of Three Techniques J. Bone Joint Surg. Am., June 1, 1996; 78(6): 803 - 13. [Abstract] [Full Text]

				F. R. NOYES and S. D. BARBER-WESTIN Reconstruction of the Anterior Cruciate Ligament with Human Allograft. Comparison of Early and Later Results J. Bone Joint Surg. Am., April 1, 1996; 78(4): 524 - 37. [Abstract] [Full Text]

				T. GRØNTVEDT, L. ENGEBRETSEN, P. BENUM, O. FASTING, A. MØLSTER, and T. STRAND A Prospective, Randomized Study of Three Operations for Acute Rupture of the Anterior Cruciate Ligament. Five-Year Follow-up of One Hundred and Thirty-one Patients J. Bone Joint Surg. Am., February 1, 1996; 78(2): 159 - 69. [Abstract] [Full Text]

				M. Marcacci, S. Zaffagnini, F. Iacono, M. Pia Neri, and A. Petitto Early Versus Late Reconstruction for Anterior Cruciate Ligament Rupture: Results After Five Years of Followup Am. J. Sports Med., December 1, 1995; 23(6): 690 - 693. [Abstract] [PDF]

				T. Grontvedt, L. Engebretsen, I. Rossvoll, O. Smevik, and G. Nilsen Comparison Between Magnetic Resonance imaging Findings and Knee Stability: Measurements After Anterior Cruciate Ligament Repair With and Without Augmentation: A Five- to Seven-Year Followup of 52 Patients Am. J. Sports Med., December 1, 1995; 23(6): 729 - 735. [Abstract] [PDF]

				A. F. Anderson, R. B. Snyder, and A. B. Lipscomb Sr. Anterior Cruciate Ligament Reconstruction Using the Semitendinosus and Gracilis Tendons Augmented by the Losee Iliotibial Band Tenodesis: A Long-term Study Am. J. Sports Med., September 1, 1994; 22(5): 620 - 626. [Abstract] [PDF]

				D. M. Daniel, M. L. Stone, B. E. Dobson, D. C. Fithian, D. J. Rossman, and K. R. Kaufman Fate of the ACL-injured Patient: A Prospective Outcome Study Am. J. Sports Med., September 1, 1994; 22(5): 632 - 644. [Abstract] [PDF]

				F. T. Blevins, A. T. Hecker, G. T. Bigler, A. L. Boland, and W. C. Hayes The Effects of Donor Age and Strain Rate on the Biomechanical Properties of Bone-Patellar Tendon-Bone Allografts Am. J. Sports Med., June 1, 1994; 22(3): 328 - 333. [Abstract] [PDF]

				N. A. Sgaglione, W. Del Pizzo, J. M. Fox, and M. J. Friedman Arthroscopically assisted anterior cruciate ligament reconstruction with the pes anserine tendons: Comparison of results in acute and chronic ligament deficiency Am. J. Sports Med., March 1, 1993; 21(2): 249 - 256. [Abstract] [PDF]

				R. R. Wroble, E. S. Grood, J. S. Cummings, J. M. Henderson, and F. R. Noyes The role of the lateral extraarticular restraints in the anterior cruciate ligament-deficient knee Am. J. Sports Med., March 1, 1993; 21(2): 257 - 263. [Abstract] [PDF]

				T. D. Rosenberg, J. L. Franklin, G. N. Baldwin, and K. A. Nelson Extensor mechanism function after patellar tendon graft harvest for anterior cruciate ligament reconstruction Am. J. Sports Med., September 1, 1992; 20(5): 519 - 526. [Abstract] [PDF]

				P. Kannus, M. Jarvinen, R. Johnson, P. Renstrom, M. Pope, B. Beynnon, C. Nichols, and M. Kaplan Function of the quadriceps and hamstrings muscles in knees with chronic partial deficiency of the anterior cruciate ligament: Isometric and isokinetic evaluation Am. J. Sports Med., March 1, 1992; 20(2): 162 - 168. [Abstract] [PDF]

				C. Andersson and J. Gillquist Treatment of acute isolated and combined ruptures of the anterior cruciate ligament: A long-term follow-up study Am. J. Sports Med., January 1, 1992; 20(1): 7 - 12. [Abstract] [PDF]

				B. R. Bach JR, D. J. Daluga, R. Mikosz, T. P. Andriacchi, and R. Seidl Force displacement characteristics of the posterior cruciate ligament Am. J. Sports Med., January 1, 1992; 20(1): 67 - 72. [Abstract] [PDF]

				L. Engebretsen, P. Benum, O. Fasting, A. Molster, and T. Strand A prospective, randomized study of three surgical techniques for treatment of acute ruptures of the anterior cruciate ligament Am. J. Sports Med., December 1, 1990; 18(6): 585 - 590. [Abstract] [PDF]

				K. D. Shelbourne, H. J. Whitaker, J. R. McCarroll, A. C. Rettig, and L. D. Hirschman Anterior cruciate ligament injury: Evaluation of intraarticular reconstruction of acute tears without repair: Two to seven year followup of 155 athletes Am. J. Sports Med., September 1, 1990; 18(5): 484 - 489. [Abstract] [PDF]

				K. D. Shelbourne and P. Nitz Accelerated rehabilitation after anterior cruciate ligament reconstruction Am. J. Sports Med., June 1, 1990; 18(3): 292 - 299. [Abstract] [PDF]