Planning Treatment for Patients with ACL TearsShould high-level athletes have surgery to repair a ruptured anterior cruciate ligament? If yes, how soon should the operation be done? Is there any benefit in delaying the inevitable?
These are all questions that are put to the test in this study. Physical therapists from the University of Delaware conducted their research in an effort to find a tool to guide patient decision and management after ACL tears.
Based on studies done so far, there isn't a lot of support for nonoperative care. But there is some evidence that athletes who injure their ACL can resume sports without surgery to repair the damage. Some are even able to play for a full year without any further problems or knee instability.
It would be good to find a way to assess patients and determine who is going to need surgery. Likewise, it's important to know when to advise athletes to go the nonoperative route. Athletes also need to know what levels of activity won't increase their risk for further injury. The results of this study may help provide this information.
An algorithm was used to classify patients into rehab versus surgery groups. Algorithm is a decision tree with factors to consider at each step of the process. For example, athletes with ACL tears and full-thickness cartilage tears were not included in the screening process. Their risk of reinjury was too great.
Patients with full knee motion and who could hop on the injured leg without pain went to rehab. If there was swelling, difficulty weight-bearing, or ongoing pain, then physical therapy treatment of the problem was started first before rehab.
Anyone who still had impairment after one month of rehab was referred to the surgeon. Thirty days was considered plenty of time for a performance athlete trying to get back into the game to recover. If problems weren't taken care of by then, surgery was likely needed.
The screening exam and algorithm presented in this article can help identify rehab candidates after ACL injury. Surgery is needed to return many high-level athletes back to a pre-injury level of play. But it is possible for some athletes to delay surgery with a full rehab program.
These athletes can return to sports without further episodes of knee instability. The results of this study showed that more athletes can rehab and return to their sport without surgery than was previously thought possible.
Wendy J. Hurd, PT, PhD, et al. A 10-Year Prospective Trial of a Patient Management Algorithm and Screening Examination for Highly Active Individuals with Anterior Cruciate Ligament Injury. In The American Journal of Sports Medicine. January 2008. Vol. 36. No. 1. Pp. 40-47.
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