Summary

This retrospective pair-matched follow-up study of former high level athletes showed no differences between operative and conservative treatment of ACL ruptures, 20 years after treatment or in the change between 10 and 20 years.

Abstract

Introduction

An anterior cruciate ligament (ACL) rupture has major implications for the patient on the mid-term; an old knee often in a young patient. The long-term effects of operative versus conservative therapy are still unclear. The current 20 year follow-up study was performed, as a sequel to our 10-year follow-up study, to gain more understanding about the long-term effects of operative versus non-operative treatment of ACL ruptures.
The aim was to present the long-term outcomes of high-level athletes with an ACL rupture treated either operatively or non-operatively with regards to the presence of OA, patient’s activity level, functional outcomes, the amount of meniscectomies performed and knee stability.
To ensure this aim we compared two pair-matched groups of high-level athletes treated for their ACL rupture either operatively with a bone-patellar-tendon-bone (BPTB) technique or non-operatively by following a physiotherapist led exercise program for a minimum duration of 3 months.

Methods

This is a pair-matched study presenting the 20-year follow-up outcomes of patients with an ACL rupture treated operatively or non-operatively. All patients who participated in our 10-year follow-up study were eligible for inclusion. All were high-level athletes with a median pre-injury Tegner 9 (interquartile range 7 to 9) and an ACL rupture treated either operatively of non-operatively. Written informed consent was obtained from all included patients and the study was approved by the institutions’ Medical Ethics Committees. Radiographs were taken of both hands and knees and clinical outcomes were assessed with the Lysholm score, IKDC subjective and objective, five KOOS-subscales and the one-leg-hop-test.

Results

At 20 years follow up twenty (80%) patients from the operative group compared to 17 (68%) from the conservative group had OA. This difference was not statistically significant (p = 0.508). No differences were found regarding the total amount of meniscus lesions, subjective outcomes and objective outcomes at 20 years follow-up, nor in the change between 10 and 20 years. At follow-up, the conservative group showed significantly more instability measured with the KT-1000 arthrometer (p = 0.002), as well as tested with the Pivot Shift (p = 0.001 ) and the Lachman test (p = 0.001 ).

Conclusion

This retrospective pair-matched follow-up study of former high level athletes showed no differences between operative and conservative treatment of ACL ruptures, 20 years after treatment or in the change between 10 and 20 years. Reconstruction did not turn out to be superior over conservative treatment, and therefore, even in high-level athletes a conservative treatment could be a suitable therapy.