NEJM Study: Some ACL Tears May Not Need Quick Surgery

The Wall Street Journal Health Blog—July 21, 2010

Want to see a soccer player shiver? Just whisper “ACL tear.”

A serious injury to the anterior cruciate ligament is one of the injuries most feared by athletes involved in sports demanding a lot of pivoting and planting action — such as those who ski or play basketball, soccer or tennis. (For reasons not fully understood, ACL tears are more prevalent in females.)

And according to statistics cited in a new study published in the New England Journal of Medicine, at least 200,000 ACL reconstructions are performed annually in the U.S. The study starts from the premise that “the optimal management” of ACL tears is unknown and some surgeries can be avoided — but in whom?

Researchers randomized 121 “young, active adults with acute ACL tears” to one of two treatment protocols: rehabilitation followed by surgery within 10 weeks of the injury, or rehab plus delayed surgery performed only if their symptoms later required it. Scores based on a patient’s pain, symptoms, sports and activity function and knee-related quality of life were calculated at the beginning of the study and then two years out.

The study found that after two years, the difference in scores wasn’t much different in the groups, suggesting that at least for non-elite athletes aged 18-35, “a strategy of rehabilitation plus early ACL reconstruction was not superior to a strategy of rehabilitation plus optional delayed reconstruction.”

David Altchek, M.D., an orthopedic surgeon and co-chief of the sports medicine and shoulder service at Hospital for Special Surgery, tells the Health Blog that in general, people who like to play (and want to keep playing) those pivoting and planting sports — whatever their fitness or skill level — are candidates for early surgery. More likely to consider the wait-and-see approach are people who, even if active in activities like running and biking, don’t do those sports.

Read the full article at wsj.com.