Time for a Different Approach to Anterior Cruciate Ligament Injuries: Educate and Create Realistic Expectations
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Time for a Different Approach to Anterior Cruciate Ligament Injuries: Educate and Create Realistic Expectations Joshua Robert Zadro1,2 · Evangelos Pappas3
© Springer Nature Switzerland AG 2018
Abstract Following an anterior cruciate ligament (ACL) injury, patients are often reassured that timely surgery followed by intensive physiotherapy will “fix their knee”. Not only does this message create a false perception of uncomplicated return to sport (RTS), it also ignores the large body of evidence demonstrating a high RTS re-injury rate following ACL reconstruction. In this article, we propose an individualised approach to the management of ACL injuries that targets a shift away from early surgery and towards conservative management, with surgery ‘as needed’ and rehabilitation tailored to the patient’s RTS goals. Education on the natural history of ACL injuries will ensure patients are not misguided into thinking surgery and intensive rehabilitation guarantees great outcomes. Further, understanding that conservative management is not inferior to surgery—and not more likely to cause knee osteoarthritis—will help the patient make an informed decision. For patients who opt for surgical management, rehabilitation must target strength and functional performance, avoid rapid increases in training load, and be guided by an RTS timeframe that is no shorter than 9 months. The content of rehabilitation should be similar for patients who opt for non-operative management, although the RTS timeframe will likely be shorter. All patients should receive education on the relationship between injury risk and training load, and understand that a home-exercise program is not inferior to intensive physiotherapist-led exercise.
Key Points Education on the natural history of anterior cruciate ligament (ACL) injuries will ensure patients are not misguided into thinking surgery and intensive rehabilitation will “fix their knee”. Patients need to be aware that conservative management of ACL injuries (with surgery ‘as needed’) is not inferior to early surgery for improving symptoms, function, quality of life, and sports participation, and the likelihood of developing knee osteoarthritis is no different between either approach.
* Joshua Robert Zadro [email protected] 1
School of Public Health, Sydney Medical School, The University of Sydney, C39‑Level 10 North, King George V Building, Royal Prince Alfred Hospital, Missenden Road, PO Box M179, Sydney, NSW 2050, Australia
2
Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia
3
Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
Rehabilitation must target strength and functional performance, avoid rapid increases in training load, and be guided by a return to sport (RTS) timeframe that is no shorter than 9 months (postoperative rehabilitation only). Home-exercise is not inferior to physiotherapist-led rehabilitation following ACL reconstruction, but there is n
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