Non-operative treatment of ACL tears FAILS in 89% of younger patients.

“The Role of Patient Characteristics in the Success of Nonoperative Treatment of Anterior Cruciate Ligament Injuries”
van der List et al.
The American Journal of Sports Medicine 2020 (May): https://doi.org/10.1177%2F0363546520917386

This high quality Level 2 evidence study from The Netherlands evaluated the outcomes of nearly 500 patients with ACL tears. The authors made some interesting and important findings:

• About 50% of patients initially attempted conservative management, through physiotherapy rehab alone (i.e. without surgery).
• Of these patients, 60% ended up needing to go ahead with surgical ACL reconstruction.
• Attempted non-operative treatment failed in 89% of patients under the age of 25, and in 56% of patients aged 25 to 40.
• The likelihood of failure of attempted conservative management was also significantly higher in those patients who participated in impact-type sports.
• There were over 500% more new meniscal tears in the group who initially attempted non-surgical treatment compared to the group who went ahead with early surgical reconstruction.

The authors of this excellent study conclude that early ACL reconstruction should be considered particularly in younger, more-active patients, to prevent unnecessary delay and to try and reduce the incidence of meniscal tears developing.

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