Abstract
BackgroundStudies with less than 10 years of follow-up have demonstrated no difference between surgical and non-surgical treatment after an anterior cruciate ligament (ACL) rupture; however, long-term effects remain unclear. The aim of this study was to compare the risk of long-term secondary surgical procedures after primary surgical and non-surgical treatment for ACL ruptures. MethodsPatients aged 18–35, registered in the Danish National Patient Registry with an ACL rupture between January 1, 1996 and December 31, 2000 with a minimum of 20 years follow-up were included. The surgically treated group was defined as receiving an ACL reconstruction within 1 year after diagnosis. Major secondary surgical procedures were defined as subsequent ACL surgeries (reconstruction/revision), arthroplasty, deep infection, arthrodesis, or amputation. Minor secondary surgical procedures were defined as meniscal surgery, synovectomy, and manipulation under anesthesia (MUA). Multivariate regression analysis was performed to assess relative risk (RR), adjusted for age and sex. The results are reported with 95% confidence intervals. Results7,539 patients had an ACL rupture; 1,970 patients were surgically treated. In the surgically treated group, 5.9% of patients underwent major secondary surgeries; this was 6.1% in the non-surgically treated group, yielding an adjusted RR of 1.05 (0.85;1.30). There were 43.9% minor secondary surgeries in the surgically treated group and 49.1% in the non-surgically treated group, yielding an adjusted RR of 1.29 (1.20;1.39). ConclusionsNo significant differences in the rate of major secondary surgical procedures between the groups, the non-surgical group was associated with a higher risk of minor secondary surgeries.
Highlights
Rupture of the anterior cruciate ligament (ACL) is a common knee injury that often occurs during sports activities, typically in those involving deceleration, twisting, and cutting movements, and ACL injuries are most often seen in young, physically active patients [1]
We found no significant difference in major secondary surgeries between the two groups, and generally, there was a low occurrence of major secondary surgeries in both groups (6%)
We found no differences in ACL reconstruction or secondary reconstructions between the non-surgically treated and surgically treated patients, and we have no reason to believe there will be any larger differences after 20 years, as we have a cohort with complete national follow-up
Summary
Rupture of the anterior cruciate ligament (ACL) is a common knee injury that often occurs during sports activities, typically in those involving deceleration, twisting, and cutting movements, and ACL injuries are most often seen in young, physically active patients [1]. Treatment for ACL rupture generally falls into one of two categories – surgical reconstruction, nowadays with minimally invasive techniques, and non-surgical treatment with a physiotherapy program. In the surgically treated group, 5.9% of patients underwent major secondary surgeries; this was 6.1% in the non-surgically treated group, yielding an adjusted RR of 1.05 (0.85;1.30). Conclusions: No significant differences in the rate of major secondary surgical procedures between the groups, the non-surgical group was associated with a higher risk of minor secondary surgeries.
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