Acute anterior cruciate ligament injuries : evaluation of surgical och non-surgical treatment

Abstract: This study comprising 6 separate papers is concerned with the treatment of patients with acute anterior cruciate ligament (ACL) injury. The aim was to compare primary surgical and non-surgical ACL treatment. Treatment was, therefore, instituted at random in all consecutive patients (n = 293) with ACL injury.Initially all patients were investigated by arthroscopy and examined under anesthesia.After 4 years patients treated by ACL repair with combined intraarticular and extraarticular augmentation had a better stability, fewer knee symptoms and a higher level of activity than patients treated by nonaugmented ACL repair or by repair of the associated injuries alone. The patients in the latter group commonly developed instability symptoms and ACL reconstruction was required in 20"7o ofthem. Also they frequently had subsequent meniscal injuries, and an impaired knee function at one-leg-hop tests for distance. Running tests, however, was not correlated to ACL treatment.Another group of patients with acute ACL injury did not have any primary ligamentous repair. At one year 200Jo of the patients needed reconstructive surgery. Moreover, anteriorposterior laxity at one year was increased compared to the initial measurements. The greatest initial laxity was found in patients with an associated tear of the medial collateral ligament (MCL). The patients with combined ACL and MCL injuries had the worst prognosis.In patients with combined injuries who had primary repair of grade 2-3 MCL tears the outcome was similar as for patients with isolated ACL lesion.A simple device for static measurements of anterior-posterior knee displacement was valuable for evaluating the results of ACL treatment. lt can also be used as an aid in the diagnosis of acute knee injury.