Picture this scenario. Skippy, a 41 year old male software engineer comes into your clinic after tearing his right ACL when he slipped on a floppy disk at work. He lifts weights at the gym 3 days a week and runs 2 miles on the treadmill 2 days a week. On his first visit Skippy asks “should I get my ACL reconstructed?”
In the recent past this would not have even been a question. Still today, most patients who tear their ACL are encouraged to have it reconstructed. Without a reconstruction patients have been expected to have reduced function, knee instability, meniscus tears, osteoarthritis etc….
More recently studies have started to call into question the practice of automatically reconstructing ACLs on every patient. Some patients are being classified as copers and are expected to function well with an ACL deficient knee.
A recent study by Frobell et al in BMJ adds to the mounting evidence which calls into question early and blanket ACL reconstruction. The authors followed a group (121) of patients (average age of 26 and “active”) who either had early ACL reconstruction or delayed optional surgery. 49% of the patients in the delayed group decided not to have an ACL reconstruction.
At the 5 year follow-up, outcomes for the two groups were similar. Early ACL reconstruction did not lead to improved outcomes or reduced incidence of subsequent meniscus injury.