6 months after injury

and the other 7 at between 2 and 5 years. At 5 years, the change in KOOS in the early ACL reconstruction group was 42.9 units and the change in the comparison group was 44.9 units (mean difference 2.0 units, 95% CI −8.5 to 4.5 units). There were no between-group differences for any of the KOOS subscales, SF-36, numbers returning to pre-injury activity level (n = 14 in early ACL reconstruction, n = 12 in delayed optional ACL reconstruction group), or radiographic osteoarthritis (n = 9 in early ACL reconstruction group, n = 4 in delayed optional ACL reconstruction group). Conclusion: After rupture of the ACL ligament early ACL reconstruction surgery did not provide better results than providing a program of rehabilitation see more with the option of having delayed surgery. Not all young active adults who rupture their ACL ligament require ACL reconstruction surgery. Identifying the best treatment approach for an acute anterior cruciate ligament (ACL) injury is a holy grail for clinicians and researchers. ACL reconstruction has long been considered the treatment of choice for young, active people

with an ACL injury. Surprisingly there are few randomised studies comparing the efficacy of surgery to other treatments. A recent systematic review suggests one in three people may not return to their previous level of sport after surgery (Ardern et al 2011). In the Frobell study a comprehensive assessment of knee impairments, activities, participation, and Cyclopamine contextual factors was completed. There Rutecarpine was no difference at 5 years between people who had early ACL

reconstruction surgery and those who had rehabilitation with the option of delayed surgery, which echoed earlier positive results from the same cohort when they were assessed at 2 years (Frobell et al 2010). People who never had surgery also did just as well as people who had early or delayed surgery. Therefore, for a young, physically active adult with an acute ACL rupture, structured rehabilitation with the option for delayed surgery may be an appropriate approach, and may help avoid unnecessary surgery without compromising short- to medium-term outcomes. Patients who had early surgery had more stable knees when compared to those who had rehabilitation with or without delayed surgery. Damage to the meniscus, rather than the ACL injury or treatment provided, may be a critical factor in the development of post-traumatic osteoarthritis (Oiestad et al 2009). There may be risk in delaying or avoiding surgery, because there is more chance for an unstable knee to sustain meniscal injury. While no differences were found in radiographic signs of osteoarthritis at 5 years, subtle changes associated with long-term disability and disease may not be visible on X-ray (Chu et al 2010). Five years follow-up may not be long enough to make judgements about the efficacy of operative or non-operative treatment in stalling the progression of osteoarthritis.