Young Active Adult
Moderate evidence supports surgical reconstruction in active young adult (18-35) patients with an ACL tear.
Rationale
The recommendation is based on one study of one prospective randomized cohort and two studies of moderate strength. 33, 34, 67, 90 The evidence indicates that ACL reconstruction decreases pathologic laxity, as measured by the Lachman, KT-1000, and pivot shift tests, and reduces episodes of instability and the incidence of subsequent injuries including meniscal tears.
Possible Harms of Implementation
As with all surgical procedures, there are patient risk including but not limited to infection, anesthetic complications, phlebitis, and neurovascular injury.
Future Research
Recommend increased attention to assessing factors important to potentially delay or prevent post-joint injury osteoarthritis such as outcomes of meniscus repair vs resection and outcomes assessing joint biology and homeostasis including restoration of normal joint biomechanics. Prospective comparative studies of nonoperative treatment and ACL reconstruction in skeletally immature patients are necessary.
Possible Harms of Implementation
As with all surgical procedures, there are patient risk including but not limited to infection, anesthetic complications, phlebitis, and neurovascular injury.
Future Research
Recommend increased attention to assessing factors important to potentially delay or prevent post-joint injury osteoarthritis such as outcomes of meniscus repair vs resection and outcomes assessing joint biology and homeostasis including restoration of normal joint biomechanics. Prospective comparative studies of nonoperative treatment and ACL reconstruction in skeletally immature patients are necessary.
- (33) Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med 2010;363:331-342.
- (34) Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ 2013;346:f232.
- (67) Marcacci M, Zaffagnini S, Iacono F, Neri MP, Petitto A. Early versus late reconstruction for anterior cruciate ligament rupture. Results after five years of followup. Am J Sports Med 1995;23:690-693.
- (90) Raviraj A, Anand A, Kodikal G, Chandrashekar M, Pai S. A comparison of early and delayed arthroscopically-assisted reconstruction of the anterior cruciate ligament using hamstring autograft. J Bone Joint Surg Br 2010;92:521-526.