Summary
A non-randomised prospective study comparing surgical ACL reconstruction to non-surgical treatment, with and without the "Cross-bracing protocol".
Abstract
Introduction
Surgical reconstruction of the ACL is considered by many the gold standard for management of ACL rupture. However, it is well established that many patients who have sustained ACL injuries have had what would be considered a successful outcome without having surgery. In more recent times in particular, there has been increased advocacy for non-surgical treatment, possibly supplemented with newer bracing techniques claiming to “reduce” the ACL into a better alignment for healing. Advocates of these techniques claim good results, even in younger active patients, whereas skeptics question the validity of these results. There is therefore a clear lack of consensus or even guidelines as to selection of the ideal management for each patient, and the intention of this study is to provide a clearer picture of the preferred treatment in each scenario.
Methods
A 3 arm study has been designed to prospectively follow patients managed surgically and non-surgically, in a non-randomised prospective cohort study. The first group consists of patients selected for non-surgical treatment via the “Cross Bracing” protocol in which initial management involves placing the knee in a brace at 90 degrees of flexion. The second group consists of patients managed non-surgically without a brace. The third group consists of patients managed surgically with ACL reconstruction. All groups follow the same standardised rehabilitation protocols and outcome assessments, including return to sport performance assessment, PROMS , GNRB laxity, and high resolution MRI scan. Secondary conversion to surgery in the non-surgical groups will be documented.
Results
At the time of writing this abstract, follow up is incomplete and therefore analysis also incomplete, but each group is showing satisfactory short term outcomes, with low rate of conversion to surgery in the non-surgical groups at short term follow up.
Conclusion
The main purpose of this study is to try and provide a more objective picture of the role of non-surgical treatment in ACL injuries, and more valid criteria for treatment selection in each patient. Non-surgical treatment of ACL injuries is becoming increasingly topical in Australia and beyond, and whilst surgical management can have excellent results and is a natural focus of study and research, I believe it is critical for a group like the ACLSG to have a clear position on this, and to lead these discussions.
( An update of results for this abstract for publishing in the official meeting abstract records can be provided later in the year )