Surgery versus conservative treatment to repair knee anterior cruciate ligament tears (ruptures) in adults

Linko E, Harilainen A, Malmivaara A, Seitsalo S

Published Online:

January 21, 2009

Anterior cruciate ligament (ACL) rupture is a common knee injury that often results in an unstable knee. Surgical treatment, usually involving reconstruction of the ligament, is widely used especially in active individuals. This review identified two randomised trials (324 people) testing outdated treatment methods. Surgical repair or augmented repair of the ligament gave better knee stability during daily activities and strenuous activities than non-surgical treatment. Functional recovery was similar with both treatments. Fewer people, however, went on to have a knee reconstruction or other knee additional surgery within the 13 to 55 months after surgical repair than following conservative treatment. No long-term information on development of arthritis was available. Overall, these studies presented some evidence that conservative treatment (immobilization, knee braces, physiotherapy) often gave acceptable recovery results. We found no randomised trials comparing modern methods of surgery with current methods of non-surgical treatment for these injuries.

Abstract (click to read)

Background:

Anterior cruciate ligament rupture is a common knee injury. Surgical treatment, usually involving reconstruction of the ligament, is widely used especially in active individuals.

Objectives:

Evaluation of the effect of surgical treatment compared with conservative treatment of anterior cruciate ligament (ACL) rupture.

Search strategy:

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to January Week 3 2005), EMBASE (1988 to 2005 Week 05), MEDIC (1978 to January 1999), Current Contents (9.2.1998 to 1.2.1999), BIOSIS (1970 to December 1998), reference lists of articles and consulted trialists and experts.

Selection criteria:

All randomised and quasi-randomised trials that compared surgical with conservative treatment of ACL rupture in adults.

Data collection and analysis:

Two authors independently performed study selection, data extraction and quality assessment.

Main results:

Two poor quality randomised trials conducted in the early 1980s were included in the review. The two trials differed considerably and no data pooling was done for the few shared outcome measures.

One quasi-randomised trial of 167 people with a complete ACL rupture treated with repair or augmented repair versus conservative treatment found no difference in the return to sports activities between people treated surgically and those treated conservatively. Measures of knee stability and functional (Lysholm) knee scores were higher in surgically-treated participants. By the end of the follow-up period (average 55 months), three people treated with repair only and 16 treated conservatively had had ACL reconstruction.

The other trial included 157 people with ACL injury. This found that conservatively-treated participants recovered from their injury more rapidly but, at the last follow up (minimum 13 months), the functional outcome was similar in both treatment groups. A large proportion of participants experienced some temporary discomfort after surgery and there were some more serious postoperative complications. There was less knee instability in surgically-treated participants and a tendency to fewer subsequent operations in the longer term.

Authors' conclusions:

There is insufficient evidence from randomised trials to determine whether surgery or conservative management was best for ACL injury in the 1980s, and no evidence to inform current practice. Good quality randomised trials are required to remedy this situation.

This record should be cited as:

Linko E, Harilainen A, Malmivaara A, Seitsalo S. Surgical versus conservative interventions for anterior cruciate ligament ruptures in adults. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD001356. DOI: 10.1002/14651858.CD001356.pub3

Assessed as up to date:

February 7, 2005

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Bone, Joint and Muscle Trauma Group

Health topics:

Orthopaedics & trauma > Soft tissue injuries > Ligament injuries in the knee

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Surgery versus conservative treatment to repair knee anterior cruciate ligament tears (ruptures) in adults

More like this

Copyright © 2011 - The Cochrane Collaboration