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    • 24 MAR 21
    • 0
    Anterior crucitiate ligament ruptures – non-operative or surgical intervention?

    Anterior crucitiate ligament ruptures – non-operative or surgical intervention?

    Anterior cruciate ligament (ACL) ruptures occurs most commonly in young and active individuals with women having almost 2 times greater risk of injury than men. They generally occur in sports that involves contact, explosive changes in direction and jumping.

    Following an ACL rupture, the objectives of management are to restore knee function, address psychological barriers to return to activities, prevent further injuries and osteoarthritis, and improve quality of life.

    Contrary to popular belief, not all ACL ruptures require a reconstruction. A high quality study showed that exercise rehabilitation alone was equally as effective as an ACL reconstruction at 2-year and 5-year follow ups. Furthermore, a study has shown that an ACL reconstruction cannot guarantee a return to pre-injury level of sport for all patients with only 65% of non-elite athletes returning to pre-injury level of sport. Better outcomes were found with elite athletes with 83% of professional athletes returning to pre-injury level of sport.

    Studies have shown that patients with ACL injuries without severe concomitant injuries to the knees (surrounding knee ligamentous ruptures, full thickness chondral lesions or complex meniscus injuries) can be managed successfully entirely through rehabilitation. However, this requires at least 5 weeks (twice a week) of supervised rehabilitation consisting of strengthening, neuromuscular control and perturbation exercises. This should be performed after the knee has near full active range of motion, little to no swelling and no quadriceps muscle lag. It is important to seek the appropriate therapist to guide patients through the appropriate rehabilitation program.

    Studies have shown that this minimum 10 session rehabilitation program post ACL injury improves both short-term and long-term outcomes in both non-operative ACL patients and ACL reconstruction patients.

    There is a misconception that the progression of knee osteoarthritis and meniscus damage is more severe in non-operative ACL patients or patients who undergo delayed ACL reconstruction; however, it is important to note that studies have shown this to be untrue. Regardless of treatment choice, knee osteoarthritis or deterioration of the meniscus has been shown to occur slowly over time post ACL injury.

    As such, rather than proceeding to immediate ACL reconstruction (that may cause further complications), the first line of treatment should be at least 5 weeks of high quality supervised rehabilitation, twice a week.

    Our exercise studio has the necessary equipment required to perform the appropriate exercise protocol that has been consistently used in ACL studies. At Complete Health we perform a thorough case history and assessment before we tailor the appropriate supervised clinical exercise program for our clients. Supervised exercise rehabilitation is important to monitor correct technique, volume and intensity while also allowing for appropriate exercise progressions.

    By Dr. Phillip Le (Osteopath)

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