Conservative versus operative treatment for anterior cruciate ligament tear:results and risk factors for osteoarthritis
Dr Frédéric SAILHANa, Dr Patricia RIBINIKb
a service de chirurgie orthopédique et traumatologique- hôpital Cochin, b service de médecine physique et de réadaptation- centre hospitalier de Gonesse
Aim : to determine from literature databases risk factors for osteoarthritis after isolated ACL tear, whether the treatment is conservative or surgical.
Materials and Methods 1985-2014 Literature Review with "osteoarthritis, ACL injury, surgery, conservative treatment, reconstructive treatment". Keywords. 45 studies meet the search criteria.
Results The course of osteoarthritic lesions did not differ between non-surgical and surgical reconstruction after isolated ACL injury. It does not depend as well on surgical technique. The aim of surgery is to control, regardless of the technique, and to remove noxious instability. It reduces the risk of secondary meniscal lesion. Its protective role in the course of degenerative lesions (excluding meniscal tears) is not established. The occurrence of degenerative lesions is potentially linked to cartilaginous lesion during initial trauma. The level of physical activity and sport also has an influence.
Discussion- Conclusion The level of evidence for clinical superiority of surgical reconstruction versus conservative treatment remains low. The frequency and speed for osteoarthritis onset, with or without surgery, is not clearly compared in the literature. The only clinical component correlated with the existence of degenerative osteoarthritic lesions is the pivot-shift test underpinning the link between residual instability and degenerative lesions. The therapeutic choice cannot be based only on the "arthrogenic risk" criterion because this risk exists in both treatments
References F. Sailhan, P. Ribinik. Prise en charge non-chirurgicale ou chirurgicale de la rupture du LCA : Résultats et risque arthrogène. Actualités en MPR Vol 2, N°4, décembre 2014
Keywords : knee osteoarthritis, ACL injury, surgery, conservative treatment, reconstructive treatment,