Examination of Osteoarthritis in Anterior Cruciate Ligament Tear Treatment Methods: A Critically Appraised Topic
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Abstract
Clinical Scenario
Anterior Cruciate Ligament (ACL) ruptures are a common injury in active populations; long term outcomes of treatment options are often questioned when selecting an intervention. Although short term outcomes are measured well, follow-up studies are less pertinent when assessing the risk of osteoarthritis (OA) development. The purpose of this study is to determine the incidence of osteoarthritis among operative versus non-operative interventions following an acute ACL rupture in active populations.
Focused Clinical Question
In patients with acute ACL ruptures, what is the effect of surgical reconstruction versus non-operative rehabilitation on the incidence of osteoarthritis?
Search Strategy
11,820 pieces of evidence were found across four databases using search terms such as ACL reconstruction, rehabilitation, conservative treatment, and osteoarthritis. Inclusion criteria included full and acute ACL rupture, no previous history of knee injuries, no associated ligamentous, meniscal, or capsular injuries, and no fractures or additional joint injuries. Exclusion criteria included partial thickness ACL tears, additional ligamentous ruptures, history of knee injuries and/or surgery, injury to the menisci and/or capsule, fractures in bones associated with the knee joint, joint injuries secondary to ACL injury, non-acute ACL rupture, and non-adherence to rehabilitation protocols.
Evidence Quality Assessment
Eight pieces of evidence were utilized following the search strategy with PEDro scores ranging from 4-to-6 and Oxford scores ranging from 2-to-4.
Results and Summary Search
Each study had similarly structured protocols including an operative group and a non-operative group, along with comparable rehabilitation protocols. Additionally, inclusion and exclusion criteria were similar in all studies, allowing for easy comparison of outcomes. Weaknesses included the inability to have blinding of the medical providers and nonspecific indication of blinding of the assessors due to surgical involvement. Additionally, the PEDro score for each study was lower due to surgical intervention. Data comparing each treatment group was compiled to determine which intervention reported better long-term joint outcomes and decreased incidence of OA.
Clinical Bottom Line
There is consistent evidence demonstrating that early ACL reconstruction (ACL-R) resulted in no higher chance of developing OA versus completing a non-operative rehabilitation program. Seven studies found no significant difference in OA development for the operative group versus the non-operative group. 4 of those 7 studies found that OA was more prevalent in the operative group than the non-operative group; however, no outcomes reported were statistically significant.1,2,3,4 One study found that patients from the ACL-R group had significantly higher International Knee Documentation Committee (IKDC) scores reported for knee stability vs. the non-operative group; 42% of the ACL-R group had developed OA, while 25% developed OA in the non-operative group.5
Implications
The literature suggests the chance of developing osteoarthritis is comparable in either intervention. Development of OA may also be influenced by other predisposing risks such as genetic and environmental factors. Future practice and patient education should consider patient history, anthropometric measurements, and the patient’s recovery expectations when selecting the best course of treatment. SORT Score: C.
Clinical Scenario
Anterior Cruciate Ligament (ACL) ruptures are a common injury in active populations; long term outcomes of treatment options are often questioned when selecting an intervention. Although short term outcomes are measured well, follow-up studies are less pertinent when assessing the risk of osteoarthritis (OA) development. The purpose of this study is to determine the incidence of osteoarthritis among operative versus non-operative interventions following an acute ACL rupture in active populations.
Focused Clinical Question
In patients with acute ACL ruptures, what is the effect of surgical reconstruction versus non-operative rehabilitation on the incidence of osteoarthritis?
Search Strategy
11,820 pieces of evidence were found across four databases using search terms such as ACL reconstruction, rehabilitation, conservative treatment, and osteoarthritis. Inclusion criteria included full and acute ACL rupture, no previous history of knee injuries, no associated ligamentous, meniscal, or capsular injuries, and no fractures or additional joint injuries. Exclusion criteria included partial thickness ACL tears, additional ligamentous ruptures, history of knee injuries and/or surgery, injury to the menisci and/or capsule, fractures in bones associated with the knee joint, joint injuries secondary to ACL injury, non-acute ACL rupture, and non-adherence to rehabilitation protocols.
Evidence Quality Assessment
Eight pieces of evidence were utilized following the search strategy with PEDro scores ranging from 4-to-6 and Oxford scores ranging from 2-to-4.
Results and Summary Search
Each study had similarly structured protocols including an operative group and a non-operative group, along with comparable rehabilitation protocols. Additionally, inclusion and exclusion criteria were similar in all studies, allowing for easy comparison of outcomes. Weaknesses included the inability to have blinding of the medical providers and nonspecific indication of blinding of the assessors due to surgical involvement. Additionally, the PEDro score for each study was lower due to surgical intervention. Data comparing each treatment group was compiled to determine which intervention reported better long-term joint outcomes and decreased incidence of OA.
Clinical Bottom Line
There is consistent evidence demonstrating that early ACL reconstruction (ACL-R) resulted in no higher chance of developing OA versus completing a non-operative rehabilitation program. Seven studies found no significant difference in OA development for the operative group versus the non-operative group. 4 of those 7 studies found that OA was more prevalent in the operative group than the non-operative group; however, no outcomes reported were statistically significant.1,2,3,4 One study found that patients from the ACL-R group had significantly higher International Knee Documentation Committee (IKDC) scores reported for knee stability vs. the non-operative group; 42% of the ACL-R group had developed OA, while 25% developed OA in the non-operative group.5
Implications
The literature suggests the chance of developing osteoarthritis is comparable in either intervention. Development of OA may also be influenced by other predisposing risks such as genetic and environmental factors. Future practice and patient education should consider patient history, anthropometric measurements, and the patient’s recovery expectations when selecting the best course of treatment. SORT Score: C.
College
College of Nursing & Health Sciences
Department
Health, Exercise & Rehabilitative Sciences
Campus
Winona
First Advisor/Mentor
Nora Kraemer
Second Advisor/Mentor
Brian Zeller
Presentation Type
Oral Presentation
Format of Presentation or Performance
Pre-Recorded Video
Examination of Osteoarthritis in Anterior Cruciate Ligament Tear Treatment Methods: A Critically Appraised Topic
Clinical Scenario
Anterior Cruciate Ligament (ACL) ruptures are a common injury in active populations; long term outcomes of treatment options are often questioned when selecting an intervention. Although short term outcomes are measured well, follow-up studies are less pertinent when assessing the risk of osteoarthritis (OA) development. The purpose of this study is to determine the incidence of osteoarthritis among operative versus non-operative interventions following an acute ACL rupture in active populations.
Focused Clinical Question
In patients with acute ACL ruptures, what is the effect of surgical reconstruction versus non-operative rehabilitation on the incidence of osteoarthritis?
Search Strategy
11,820 pieces of evidence were found across four databases using search terms such as ACL reconstruction, rehabilitation, conservative treatment, and osteoarthritis. Inclusion criteria included full and acute ACL rupture, no previous history of knee injuries, no associated ligamentous, meniscal, or capsular injuries, and no fractures or additional joint injuries. Exclusion criteria included partial thickness ACL tears, additional ligamentous ruptures, history of knee injuries and/or surgery, injury to the menisci and/or capsule, fractures in bones associated with the knee joint, joint injuries secondary to ACL injury, non-acute ACL rupture, and non-adherence to rehabilitation protocols.
Evidence Quality Assessment
Eight pieces of evidence were utilized following the search strategy with PEDro scores ranging from 4-to-6 and Oxford scores ranging from 2-to-4.
Results and Summary Search
Each study had similarly structured protocols including an operative group and a non-operative group, along with comparable rehabilitation protocols. Additionally, inclusion and exclusion criteria were similar in all studies, allowing for easy comparison of outcomes. Weaknesses included the inability to have blinding of the medical providers and nonspecific indication of blinding of the assessors due to surgical involvement. Additionally, the PEDro score for each study was lower due to surgical intervention. Data comparing each treatment group was compiled to determine which intervention reported better long-term joint outcomes and decreased incidence of OA.
Clinical Bottom Line
There is consistent evidence demonstrating that early ACL reconstruction (ACL-R) resulted in no higher chance of developing OA versus completing a non-operative rehabilitation program. Seven studies found no significant difference in OA development for the operative group versus the non-operative group. 4 of those 7 studies found that OA was more prevalent in the operative group than the non-operative group; however, no outcomes reported were statistically significant.1,2,3,4 One study found that patients from the ACL-R group had significantly higher International Knee Documentation Committee (IKDC) scores reported for knee stability vs. the non-operative group; 42% of the ACL-R group had developed OA, while 25% developed OA in the non-operative group.5
Implications
The literature suggests the chance of developing osteoarthritis is comparable in either intervention. Development of OA may also be influenced by other predisposing risks such as genetic and environmental factors. Future practice and patient education should consider patient history, anthropometric measurements, and the patient’s recovery expectations when selecting the best course of treatment. SORT Score: C.
Clinical Scenario
Anterior Cruciate Ligament (ACL) ruptures are a common injury in active populations; long term outcomes of treatment options are often questioned when selecting an intervention. Although short term outcomes are measured well, follow-up studies are less pertinent when assessing the risk of osteoarthritis (OA) development. The purpose of this study is to determine the incidence of osteoarthritis among operative versus non-operative interventions following an acute ACL rupture in active populations.
Focused Clinical Question
In patients with acute ACL ruptures, what is the effect of surgical reconstruction versus non-operative rehabilitation on the incidence of osteoarthritis?
Search Strategy
11,820 pieces of evidence were found across four databases using search terms such as ACL reconstruction, rehabilitation, conservative treatment, and osteoarthritis. Inclusion criteria included full and acute ACL rupture, no previous history of knee injuries, no associated ligamentous, meniscal, or capsular injuries, and no fractures or additional joint injuries. Exclusion criteria included partial thickness ACL tears, additional ligamentous ruptures, history of knee injuries and/or surgery, injury to the menisci and/or capsule, fractures in bones associated with the knee joint, joint injuries secondary to ACL injury, non-acute ACL rupture, and non-adherence to rehabilitation protocols.
Evidence Quality Assessment
Eight pieces of evidence were utilized following the search strategy with PEDro scores ranging from 4-to-6 and Oxford scores ranging from 2-to-4.
Results and Summary Search
Each study had similarly structured protocols including an operative group and a non-operative group, along with comparable rehabilitation protocols. Additionally, inclusion and exclusion criteria were similar in all studies, allowing for easy comparison of outcomes. Weaknesses included the inability to have blinding of the medical providers and nonspecific indication of blinding of the assessors due to surgical involvement. Additionally, the PEDro score for each study was lower due to surgical intervention. Data comparing each treatment group was compiled to determine which intervention reported better long-term joint outcomes and decreased incidence of OA.
Clinical Bottom Line
There is consistent evidence demonstrating that early ACL reconstruction (ACL-R) resulted in no higher chance of developing OA versus completing a non-operative rehabilitation program. Seven studies found no significant difference in OA development for the operative group versus the non-operative group. 4 of those 7 studies found that OA was more prevalent in the operative group than the non-operative group; however, no outcomes reported were statistically significant.1,2,3,4 One study found that patients from the ACL-R group had significantly higher International Knee Documentation Committee (IKDC) scores reported for knee stability vs. the non-operative group; 42% of the ACL-R group had developed OA, while 25% developed OA in the non-operative group.5
Implications
The literature suggests the chance of developing osteoarthritis is comparable in either intervention. Development of OA may also be influenced by other predisposing risks such as genetic and environmental factors. Future practice and patient education should consider patient history, anthropometric measurements, and the patient’s recovery expectations when selecting the best course of treatment. SORT Score: C.
