Comparative study of anterior cruciate ligament reconstruction versus conservative treatment among non-athletes: A 10-years follow-up

Objective: To compare outcome of conservative versus operative treatment for complete Anterior Cruciate Ligament (ACL) tear in non-athletes.

Methods: This was a prospective randomized controlled trial, total 132 Patients were enrolled and two groups were made of 68 patients in group A and 64 in group B. Group A patients were treated surgically (Arthroscopic ACL reconstruction and rehabilitation) and group B patients were treated conservatively (optional debridement and rehabilitation). The outcomes were compared using anterior laxity of knee joint (by using Lachman’s and Pivot shift test), Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score and Tegner Activity Level (TAL).

Results and Discussion: The IKDC score at final follow-up was 73.58 (SD ± 2.72) and 72.88 (SD ± 2.69) in group A and B respectively and difference was not significant (p=0.140). The KOOS at final follow-up was 77.75 (SD ± 2.42) and 76.79 (SD ± 3.10) in group A and B respectively and difference was not significant (p=0.052). The TAL at final follow-up was 4.07 (SD ± 0.76) and 3.94 (SD ± 0.75) in group A and B respectively and difference was not significant (p=0.304). At final follow up the reconstructed group showed a positive pivot shift in 29.4% of the cases (10.3% grade 2 and 19.1% grade 1), and positive Lachman test in 29.4% (7.4% grade 1A and 22.1% grade 2A) cases. The patients in non-operative group showed positive Pivot shift (54.7% grade 1 and 45.3% grade 2) and positive Lachman test (46.9% grade 1B and 53.1% grade 2B). Although in term of instability surgically treated group was found better but functionally there was no difference between two groups.

Conclusion: This study revealed both the conservatively treated and the reconstructed group, performed similarly, except for a higher objectively measurable instability in the conservative group. However, they are just as satisfied with their knee without an operation at final follow-up, showing no difference in activity level and functional outcome subjectively. Therefore, conservative treatment should still be considered a treatment option for an ACL insufficient knee in non-athletes.