Twenty-Year Follow-up Study Comparing Operative Versus Nonoperative Treatment of Anterior Cruciate Ligament Ruptures in High-Level Athletes
Background: An anterior cruciate ligament (ACL) rupture has major consequences at midterm follow-up, with an increasing chance of developing an old knee in a young patient. The long-term (≥20 years) effects of the operative and nonoperative treatment of ACL ruptures are still unclear. Purpose: To co...
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| Veröffentlicht in: | The American journal of sports medicine 2018-04, Vol.46 (5), p.1129-1136 |
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| creator | van Yperen, Daan T. Reijman, Max van Es, Eline M. Bierma-Zeinstra, Sita M.A. Meuffels, Duncan E. |
| description | Background:
An anterior cruciate ligament (ACL) rupture has major consequences at midterm follow-up, with an increasing chance of developing an old knee in a young patient. The long-term (≥20 years) effects of the operative and nonoperative treatment of ACL ruptures are still unclear.
Purpose:
To compare the long-term treatment outcomes of operative versus nonoperative treatment of ACL ruptures in high-level athletes.
Study Design:
Cohort study; Level of evidence, 2.
Methods:
Fifty patients with an ACL rupture were eligible for participation, and they were treated either nonoperatively (n = 25) in 1992, consisting of structured rehabilitation and lifestyle adjustments, or operatively (n = 25) between 1994 and 1996 with an arthroscopic transtibial bone–patellar tendon–bone technique. The patients in the nonoperative group were drawn from those who responded well to 3 months of nonoperative treatment, whereas the patients in the operative group were drawn from those who had persistent instability after 3 months of nonoperative treatment. Both groups were pair-matched and assessed at 10- and 20-year follow-up regarding radiological knee osteoarthritis, functional outcomes (Lysholm, International Knee Documentation Committee [IKDC], Tegner, Knee injury and Osteoarthritis Outcome Score), meniscal status, and knee stability (KT-1000 arthrometer, pivot-shift test, Lachman test, 1-legged hop test).
Results:
All 50 patients (100%) were included in the current study for follow-up. After 20 years, we found knee osteoarthritis in 80% of the operative group compared with 68% of the nonoperative group (P = .508). There was no difference between groups regarding functional outcomes and meniscectomy performed. The median IKDC subjective score was 81.6 (interquartile range [IQR], 59.8-89.1) for the operative group and 78.2 (IQR, 61.5-92.0) for the nonoperative group (P = .679). Regarding the IKDC objective score, 21 patients (84%) in the operative group had a normal or near normal score (A and B) compared with 5 patients (20%) in the nonoperative group (P < .001). The pivot-shift test finding was negative in 17 patients (68%) versus 3 patients (13%) for the operative and nonoperative groups, respectively (P < .001), and the Lachman test finding was negative in 12 patients (48%) versus 1 patient (4%), respectively (P = .002).
Conclusion:
In this retrospective pair-matched follow-up study, we found that after 20-year follow-up, there was no difference in knee osteoarthritis |
| doi_str_mv | 10.1177/0363546517751683 |
| format | Article |
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An anterior cruciate ligament (ACL) rupture has major consequences at midterm follow-up, with an increasing chance of developing an old knee in a young patient. The long-term (≥20 years) effects of the operative and nonoperative treatment of ACL ruptures are still unclear.
Purpose:
To compare the long-term treatment outcomes of operative versus nonoperative treatment of ACL ruptures in high-level athletes.
Study Design:
Cohort study; Level of evidence, 2.
Methods:
Fifty patients with an ACL rupture were eligible for participation, and they were treated either nonoperatively (n = 25) in 1992, consisting of structured rehabilitation and lifestyle adjustments, or operatively (n = 25) between 1994 and 1996 with an arthroscopic transtibial bone–patellar tendon–bone technique. The patients in the nonoperative group were drawn from those who responded well to 3 months of nonoperative treatment, whereas the patients in the operative group were drawn from those who had persistent instability after 3 months of nonoperative treatment. Both groups were pair-matched and assessed at 10- and 20-year follow-up regarding radiological knee osteoarthritis, functional outcomes (Lysholm, International Knee Documentation Committee [IKDC], Tegner, Knee injury and Osteoarthritis Outcome Score), meniscal status, and knee stability (KT-1000 arthrometer, pivot-shift test, Lachman test, 1-legged hop test).
Results:
All 50 patients (100%) were included in the current study for follow-up. After 20 years, we found knee osteoarthritis in 80% of the operative group compared with 68% of the nonoperative group (P = .508). There was no difference between groups regarding functional outcomes and meniscectomy performed. The median IKDC subjective score was 81.6 (interquartile range [IQR], 59.8-89.1) for the operative group and 78.2 (IQR, 61.5-92.0) for the nonoperative group (P = .679). Regarding the IKDC objective score, 21 patients (84%) in the operative group had a normal or near normal score (A and B) compared with 5 patients (20%) in the nonoperative group (P < .001). The pivot-shift test finding was negative in 17 patients (68%) versus 3 patients (13%) for the operative and nonoperative groups, respectively (P < .001), and the Lachman test finding was negative in 12 patients (48%) versus 1 patient (4%), respectively (P = .002).
Conclusion:
In this retrospective pair-matched follow-up study, we found that after 20-year follow-up, there was no difference in knee osteoarthritis between operative versus nonoperative treatment when treatment was allocated on the basis of a patient’s response to 3 months of nonoperative treatment. Although knee stability was better in the operative group, it did not result in better subjective and objective functional outcomes.</description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/0363546517751683</identifier><identifier>PMID: 29438635</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Arthritis ; Athletes ; Knee ; Ligaments ; Patients ; Sports medicine</subject><ispartof>The American journal of sports medicine, 2018-04, Vol.46 (5), p.1129-1136</ispartof><rights>2018 The Author(s)</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c407t-e8da664d6d75f01ff33428c959727bc5ab42b3ba9b588243765d81fe94f214303</citedby><cites>FETCH-LOGICAL-c407t-e8da664d6d75f01ff33428c959727bc5ab42b3ba9b588243765d81fe94f214303</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0363546517751683$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0363546517751683$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29438635$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Yperen, Daan T.</creatorcontrib><creatorcontrib>Reijman, Max</creatorcontrib><creatorcontrib>van Es, Eline M.</creatorcontrib><creatorcontrib>Bierma-Zeinstra, Sita M.A.</creatorcontrib><creatorcontrib>Meuffels, Duncan E.</creatorcontrib><title>Twenty-Year Follow-up Study Comparing Operative Versus Nonoperative Treatment of Anterior Cruciate Ligament Ruptures in High-Level Athletes</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description>Background:
An anterior cruciate ligament (ACL) rupture has major consequences at midterm follow-up, with an increasing chance of developing an old knee in a young patient. The long-term (≥20 years) effects of the operative and nonoperative treatment of ACL ruptures are still unclear.
Purpose:
To compare the long-term treatment outcomes of operative versus nonoperative treatment of ACL ruptures in high-level athletes.
Study Design:
Cohort study; Level of evidence, 2.
Methods:
Fifty patients with an ACL rupture were eligible for participation, and they were treated either nonoperatively (n = 25) in 1992, consisting of structured rehabilitation and lifestyle adjustments, or operatively (n = 25) between 1994 and 1996 with an arthroscopic transtibial bone–patellar tendon–bone technique. The patients in the nonoperative group were drawn from those who responded well to 3 months of nonoperative treatment, whereas the patients in the operative group were drawn from those who had persistent instability after 3 months of nonoperative treatment. Both groups were pair-matched and assessed at 10- and 20-year follow-up regarding radiological knee osteoarthritis, functional outcomes (Lysholm, International Knee Documentation Committee [IKDC], Tegner, Knee injury and Osteoarthritis Outcome Score), meniscal status, and knee stability (KT-1000 arthrometer, pivot-shift test, Lachman test, 1-legged hop test).
Results:
All 50 patients (100%) were included in the current study for follow-up. After 20 years, we found knee osteoarthritis in 80% of the operative group compared with 68% of the nonoperative group (P = .508). There was no difference between groups regarding functional outcomes and meniscectomy performed. The median IKDC subjective score was 81.6 (interquartile range [IQR], 59.8-89.1) for the operative group and 78.2 (IQR, 61.5-92.0) for the nonoperative group (P = .679). Regarding the IKDC objective score, 21 patients (84%) in the operative group had a normal or near normal score (A and B) compared with 5 patients (20%) in the nonoperative group (P < .001). The pivot-shift test finding was negative in 17 patients (68%) versus 3 patients (13%) for the operative and nonoperative groups, respectively (P < .001), and the Lachman test finding was negative in 12 patients (48%) versus 1 patient (4%), respectively (P = .002).
Conclusion:
In this retrospective pair-matched follow-up study, we found that after 20-year follow-up, there was no difference in knee osteoarthritis between operative versus nonoperative treatment when treatment was allocated on the basis of a patient’s response to 3 months of nonoperative treatment. Although knee stability was better in the operative group, it did not result in better subjective and objective functional outcomes.</description><subject>Arthritis</subject><subject>Athletes</subject><subject>Knee</subject><subject>Ligaments</subject><subject>Patients</subject><subject>Sports medicine</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kUtr3DAUhUVpaSZp910VQTfdqNXTspfDkDSBIYFkWujKyPb1RMG2XD0S5jf0T1fTSRMIFC2u0PnO0YWD0AdGvzCm9VcqCqFkofJdsaIUr9CCKcWJEIV6jRZ7mez1I3Qcwh2llOmifIuOeCVFma0L9HvzAFPckZ9gPD5zw-AeSJrxTUzdDq_cOBtvpy2-msGbaO8B_wAfUsCXbnJPbxsPJo45B7seL6cI3jqPVz611kTAa7s1f9XrNMfkIWA74XO7vSVruIcBL-PtABHCO_SmN0OA94_zBH0_O92szsn66tvFarkmraQ6Eig7UxSyKzqtesr6XgjJy7ZSlea6aZVpJG9EY6pGlSWXQheqK1kPlew5k4KKE_T5kDt79ytBiPVoQwvDYCZwKdScUs4Z11Jk9NML9M4lP-XtMpUPrwTTmaIHqvUuBA99PXs7Gr-rGa33RdUvi8qWj4_BqRmhezL8ayYD5AAEs4XnX_8b-AdB1ZtU</recordid><startdate>201804</startdate><enddate>201804</enddate><creator>van Yperen, Daan T.</creator><creator>Reijman, Max</creator><creator>van Es, Eline M.</creator><creator>Bierma-Zeinstra, Sita M.A.</creator><creator>Meuffels, Duncan E.</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>201804</creationdate><title>Twenty-Year Follow-up Study Comparing Operative Versus Nonoperative Treatment of Anterior Cruciate Ligament Ruptures in High-Level Athletes</title><author>van Yperen, Daan T. ; Reijman, Max ; van Es, Eline M. ; Bierma-Zeinstra, Sita M.A. ; Meuffels, Duncan E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c407t-e8da664d6d75f01ff33428c959727bc5ab42b3ba9b588243765d81fe94f214303</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Arthritis</topic><topic>Athletes</topic><topic>Knee</topic><topic>Ligaments</topic><topic>Patients</topic><topic>Sports medicine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Yperen, Daan T.</creatorcontrib><creatorcontrib>Reijman, Max</creatorcontrib><creatorcontrib>van Es, Eline M.</creatorcontrib><creatorcontrib>Bierma-Zeinstra, Sita M.A.</creatorcontrib><creatorcontrib>Meuffels, Duncan E.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Yperen, Daan T.</au><au>Reijman, Max</au><au>van Es, Eline M.</au><au>Bierma-Zeinstra, Sita M.A.</au><au>Meuffels, Duncan E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Twenty-Year Follow-up Study Comparing Operative Versus Nonoperative Treatment of Anterior Cruciate Ligament Ruptures in High-Level Athletes</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2018-04</date><risdate>2018</risdate><volume>46</volume><issue>5</issue><spage>1129</spage><epage>1136</epage><pages>1129-1136</pages><issn>0363-5465</issn><eissn>1552-3365</eissn><abstract>Background:
An anterior cruciate ligament (ACL) rupture has major consequences at midterm follow-up, with an increasing chance of developing an old knee in a young patient. The long-term (≥20 years) effects of the operative and nonoperative treatment of ACL ruptures are still unclear.
Purpose:
To compare the long-term treatment outcomes of operative versus nonoperative treatment of ACL ruptures in high-level athletes.
Study Design:
Cohort study; Level of evidence, 2.
Methods:
Fifty patients with an ACL rupture were eligible for participation, and they were treated either nonoperatively (n = 25) in 1992, consisting of structured rehabilitation and lifestyle adjustments, or operatively (n = 25) between 1994 and 1996 with an arthroscopic transtibial bone–patellar tendon–bone technique. The patients in the nonoperative group were drawn from those who responded well to 3 months of nonoperative treatment, whereas the patients in the operative group were drawn from those who had persistent instability after 3 months of nonoperative treatment. Both groups were pair-matched and assessed at 10- and 20-year follow-up regarding radiological knee osteoarthritis, functional outcomes (Lysholm, International Knee Documentation Committee [IKDC], Tegner, Knee injury and Osteoarthritis Outcome Score), meniscal status, and knee stability (KT-1000 arthrometer, pivot-shift test, Lachman test, 1-legged hop test).
Results:
All 50 patients (100%) were included in the current study for follow-up. After 20 years, we found knee osteoarthritis in 80% of the operative group compared with 68% of the nonoperative group (P = .508). There was no difference between groups regarding functional outcomes and meniscectomy performed. The median IKDC subjective score was 81.6 (interquartile range [IQR], 59.8-89.1) for the operative group and 78.2 (IQR, 61.5-92.0) for the nonoperative group (P = .679). Regarding the IKDC objective score, 21 patients (84%) in the operative group had a normal or near normal score (A and B) compared with 5 patients (20%) in the nonoperative group (P < .001). The pivot-shift test finding was negative in 17 patients (68%) versus 3 patients (13%) for the operative and nonoperative groups, respectively (P < .001), and the Lachman test finding was negative in 12 patients (48%) versus 1 patient (4%), respectively (P = .002).
Conclusion:
In this retrospective pair-matched follow-up study, we found that after 20-year follow-up, there was no difference in knee osteoarthritis between operative versus nonoperative treatment when treatment was allocated on the basis of a patient’s response to 3 months of nonoperative treatment. Although knee stability was better in the operative group, it did not result in better subjective and objective functional outcomes.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>29438635</pmid><doi>10.1177/0363546517751683</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0363-5465 |
| ispartof | The American journal of sports medicine, 2018-04, Vol.46 (5), p.1129-1136 |
| issn | 0363-5465 1552-3365 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2002212743 |
| source | SAGE Complete; Alma/SFX Local Collection |
| subjects | Arthritis Athletes Knee Ligaments Patients Sports medicine |
| title | Twenty-Year Follow-up Study Comparing Operative Versus Nonoperative Treatment of Anterior Cruciate Ligament Ruptures in High-Level Athletes |
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