New Guideline: Surgically Repair ACL Injury Within 5 Months
Written by Editor   
Wednesday, September 24, 2014 03:14 PM

Medscape is reporting "The American Academy of Orthopedic Surgeons (AAOS) has released a new evidence-based practice guideline for treating anterior cruciate ligament (ACL) tears.  For patients who are candidates for surgery, the new guideline contains a recommendation to perform reconstructive surgery within 5 months of an ACL injury to protect the knee joint.

What the report does not tell you is the strength of the research associated with this new guideline.  In the case of the 5 month guideline the strength of the research is MODERATE, indicating "evidence from two or more 'Moderate' strength studies with consistent findings, or evidence from a single 'High' quality study for recommending for or against the intervention." 

"In an active patient, if you wait too long to surgically repair the ACL, there is a risk for additional injury to the knee," Kevin Shea, MD, chair of the AAOS Clinical Practice Guideline on the Management of ACL Injuries work group, said in a news release. "Therefore, surgery within five months of injury may have some advantages. Nonsurgical treatment also is appropriate for some patients, including those with less active lifestyles who do not place significant demands on the knee."

Among other recommendations (followed by the strength of their research) the guideline says practitioners:

  • should take a "relevant history and perform a musculoskeletal exam of the lower extremities," – STRONG

  • should confirm ACL diagnosis and identify associated joint and cartilage problems through magnetic resonance imaging, – STRONG

  • "might perform surgical reconstruction because it reduces activity related disability and recurrent instability which may lead to additional injury,"  The full quote is "There is limited evidence in skeletally immature patients with torn ACLs, but it supports that the practitioner might ..."   – the strength of the evidence is LIMITED

  • "might repair these meniscus tears when combined with ACL reconstruction because it improves patient outcomes," – again, the full quote is "There is limited evidence in patients with combined ACL tears and reparable meniscus tears, but it supports that the practitioner might... " – the strength of this evidence is LIMITED

  • might perform nonoperative reconstruction treatment in patients with recurrent instability, – The full quote is "There is limited evidence comparing non-operative treatment to ACL reconstruction in patients with recurrent instability, but it supports that the practitioner might ..." – the strength of this evidence is LIMITED

  • may get better-measured outcomes in patients undergoing intra-articular ACL reconstruction by using either single-bundle or double-bundle technique, – MODERATE to STRONG evidence

  • should use either patellar tendon or hamstring tendons in patients undergoing intra-articular ACL reconstruction with autograft tissue. – STRONG

Other  recommendations noted in the report, but not in the reported news, include:

  • ACL Radiographs – CONSENSUS, there is no supporting evidence.
  • ACL Meniscal Repair – LIMITED evidence
  • ACL Recurrent Instability – LIMITED evidence
  • ACL Combined MCL Repair – LIMITED evidence
  • ACL Locked Knee – CONSENSUS, there is no supporting evidence.
  • ACL Prophylactic Bracing –LIMITED evidence
  • ACL Neuromuscular Training Programs –  MODERATE
  • Post-Op Physical Therapy – MODERATE
  • ACL Return to Sports – LIMITED

Source:  http://www.medscape.com/viewarticle/832146?nlid=66243_2981&src=wnl_edit_dail&uac=151914AX

Guideline:  http://www.aaos.org/Research/guidelines/ACLGuidelineFINAL.pdf