Does Anterior Cruciate Ligament Reconstruction Improve Functional and Radiographic Outcomes Over Nonoperative Management 5 Years After Injury?

Am J Sports Med. 2018 Jul;46(9):2103-2112. doi: 10.1177/0363546518782698. Epub 2018 Jun 21.


Background: Current practice patterns for the management of anterior cruciate ligament (ACL) injury favor surgical reconstruction. However, long-term outcomes may not differ between patients completing operative and nonoperative treatment of ACL injury. Differences in outcomes between operative and nonoperative treatment of patients in the United States is largely unknown, as are outcomes in long-term strength and performance measures.

Purpose: To determine if differences exist in 5-year functional and radiographic outcomes between patients completing operative and nonoperative treatment of ACL injury when both groups complete a progressive criterion-based rehabilitation protocol.

Study design: Cohort study; Level of evidence, 2.

Methods: From an original group of 144 athletes, 105 participants (mean ± SD age, 34.3 ± 11.4 years) with an acute ACL rupture completed functional testing (quadriceps strength, single-legged hop, and knee joint effusion testing; patient-reported outcomes) and knee radiographs 5 years after ACL reconstruction or completion of nonoperative rehabilitation.

Results: At 5 years, patients treated with ACL reconstruction versus rehabilitation alone did not differ in quadriceps strength ( P = .817); performance on single-legged hop tests ( P = .234-.955); activity level ( P = .349-.400); subjective reports of pain, symptoms, activities of daily living, and knee-related quality of life ( P = .090-.941); or presence of knee osteoarthritis ( P = .102-.978). When compared with patients treated nonoperatively, patients treated operatively did report greater global ratings of knee function ( P = .001), and lower fear ( P = .035) at 5 years but were more likely to possess knee joint effusion ( P = .016).

Conclusion: The current findings indicate that favorable outcomes can occur after both operative and nonoperative management approaches with the use of progressive criterion-based rehabilitation. Further study is needed to determine clinical algorithms for identifying the best candidates for surgical versus nonoperative care after ACL injury. These findings provide an opportunity to improve the educational process between patients and clinicians regarding the expected clinical course and long-term outcomes of operative and nonoperative treatment of ACL injuries.

Keywords: anterior cruciate ligament injury; fear; knee function; osteoarthritis; rehabilitation.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Activities of Daily Living
  • Adult
  • Anterior Cruciate Ligament Injuries / surgery*
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Athletes
  • Cohort Studies
  • Female
  • Humans
  • Knee Joint / surgery*
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / epidemiology
  • Quadriceps Muscle / metabolism
  • Quality of Life*
  • Radiography
  • Young Adult