Prognostic factors in management strategies of ACL ruptures
The topic of ACL injury management has amassed a lot of research interest over the last number of years. Unfortunately, due to the complexity of ACL injury and the concomitant pathologies associated, progress in determining guidelines in management continues to fall short of best practice. The current study aimed to identify prognostic factors over 5-year outcomes, best suited to aid the decision making process for the management of acute ACL ruptures.
The presence of unsatisfactory outcomes in rehabilitation is inevitable with all injuries. Determining what influences these outcomes was the approach the authors used to better understand rehabilitation and potentially lead to more optimal recovery. Therefore, the current study attempted to determine prognostic factors for recovery among 3 groups of management; early ACL reconstruction with exercise therapy, exercise therapy with delayed ACL reconstruction and exercise therapy alone.
Correlations were investigated between injury-related (meniscal, osteochondral, cartilage damage) and patient-related (pain, QoL, functional reports) prognostic variables and compared among different treatment group outcomes.
The authors concluded that evidence was found in support of a positive shift in prognosis with delayed reconstruction or exercise therapy alone when considering factors for recovery over a 5-year outcome. Furthermore, those patients reporting elevated pain and disability outcomes may benefit from exercise therapy before consideration of ACL reconstruction. Despite these positive results, due to flaws in study design, the authors suggest further research is needed before application in a clinical setting is considered.
> From: Filbay et al., Br J Sports Med (2017) (Epub ahead of print). All rights reserved to BMJ Publishing Group Ltd. Click here for the online summary.