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Long-term outcomes similar in patients treated operatively vs. conservatively for ACL ruptures

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SAN FRANCISCO — Dutch patients who underwent anterior cruciate ligament reconstruction for a ligament rupture showed similar results at 10 years as those who received conservative care, according to the findings of a recent study.

The only significant difference between the two groups was in the level of stability; patients who received bone-patella-tendon-bone (BPTB) ACL reconstruction had higher stability marks.

Both groups presented with a high number of meniscal lesions.

Researchers in the Netherlands compared the two groups according to the extent of degenerative changes in the knee, instability, activity level and subjective functional outcome, according to Duncan Meuffels, MD, of the Erasmus University Medical Center in Rotterdam, Netherlands.

He presented his findings at the American Academy of Orthopaedics 75th Annual Meeting, here.

The two groups of patients were pair-matched based on age, gender and Tegner activity score before injury. In total, 50 patients were pair-matched for the investigation.

"We found no statistically significant difference between patients treated conservatively and those treated with surgery according to objective and subjective functional outcome, degenerative changes in the knee or other lesions involving the knee," he said. "In fact, the only difference we could see was that the patients who were treated operatively had better stability of the knee and a 1-point higher Tegner score."

There was a 48% incidence of osteoarthritis symptoms in the operative group vs. 28% in the conservative group, although the researchers said they will continue to follow this. "The stabilized knee does not yet seem to give rise to more radiographic OA at this long-term follow-up," he said.

There was no significant difference among the groups in the one-leg hop test results post-treatment.

Meuffels said he and his colleagues could not cite the exact reason for the similarity between the groups, but said the benefit of better stability was encouraging for BPTB reconstruction.

For more information:

• Meuffels D, Favajee M, Vissers M, et al. Ten-year follow-up study comparing conservative vs. operative treatment of ACL ruptures. #033. Presented at the American Academy of Orthopaedic Surgeons 75th Annual Meeting. March 5-9, 2008. San Francisco.