“POP” Now what?
This is an injury usually caused by a quick stop, pivot, cutting movement or just landing awkwardly – The ACL tear. As you lie on the ground clutching your knee, what goes through your head?
This is a common scenario for soccer players and often leads to a lost season, months of physiotherapy, and an uncertain future.
Once you get a diagnosis you may be faced with two options: 1. Surgical management (repair followed by physiotherapy) or 2. Conservative management (physiotherapy only)
As physiotherapists we are evidence based practitioners, which means we must stay current in terms of the research supporting the latest treatment interventions for different pathologies. We are always asking the questions : “why?”, “has this been proven?”, “in what populations does this work?”.
A 2016 Cochrane review concluded that there was no difference in patient reported knee outcome scores for function at 2 years and 5 years post-injury between people that had surgery and people who didn’t. 1 What we know is that 20% of people who undergo surgical repair experience another rupture within 2 years, and over 50% of people that try a conservative approach go on to have surgical repair within 5 years anyway because of instability. With any surgery to the knee and with instability we have increased risk of osteoarthritis. So, what are you supposed to do?
To help us answer that question there was a study done in 2018 that helped provide some guidance and give us insight into the long term sequelae of an ACL injury. 2 This study compared 50 individuals over 20 years. In this pair matched follow-up study, after 20 years there was no difference in knee osteoarthritis between those people that had a surgical repair and those that opted for nonsurgical treatment. Treatment was allocated based on the patient’s response to a trial of 3 months of physiotherapy. Knee stability was better in the group that had surgery but that did non translate into better subjective or objective outcomes.
- Monk, A. P., Davies, L. J., Hopewell, S., Harris, K., Beard, D. J., & Price, A. J. (2016). Surgical versus conservative interventions for treating anterior cruciate ligament injuries. Cochrane Database of Systematic Reviews, (4).
- van Yperen, D. T., Reijman, M., van Es, E. M., Bierma-Zeinstra, S. M., & Meuffels, D. E. (2018). Twenty-year follow-up study comparing operative versus nonoperative treatment of anterior cruciate ligament ruptures in high-level athletes. The American journal of sports medicine, 46(5), 1129-1136.