One-third of ACL tears heal on their own.outcome uncertain

VIENNA — Nearly one-third of anterior cruciate ligament (ACL) injuries appear to heal without surgery, according to an analysis of three-dimensional MRI data from Vienna. Nacox This research was presented as a state-of-the-art poster at a recent academic meeting. World Osteoarthritis Congress (OARSI) 2024 Annual Meeting.

Three-dimensional MRI 2 years after injury showed evidence of normal continuous ACL fibers in 13 of 43 knees (30%). In addition, an additional 14 (33%) knees had continuous ACL fibrous structures after rehabilitation alone. In the remaining cases, ACL fibers were partially (16%) or completely (21%) torn.

“If you think of the ACL like a rope, continuity means the fibers have reconnected,” study co-author Stephanie PhilbeyHe is an associate professor at the University of Melbourne in Melbourne, Australia. Medscape Medical News.

“There are a number of variations in healing that we see. Some people appear as if they were never injured, while others have reattached their ACL but it appears to be thinner or longer than a normal ACL.” Some people look like ,” Philbey said.

She added, “What this study shows is that it's happening at a much higher rate than we thought. And in some studies, ACL healing is very favorable. “It seems to be related to the results,” he added.

At OARSI 2024, Philbey presented additional data from their study on the relationship between ACL healing and long-term functional outcomes and osteoarthritis (OA) incidence in a comparison of patient treatment pathways: early ACL surgery; Rehabilitation followed by delayed surgery or rehabilitation only.

cure without surgery

As Philbey explained in his talk, the idea that the ACL can be healed without surgery is relatively new and probably not yet widely accepted as a concept. Plenary lecture at OARSI 2024.

Philbey explained that the ideal management of an ACL injury depends on the severity of the knee injury and whether the knee remains stable after attempting non-surgical management.result of ACL SNNAP TrialFor example, we suggest that surgical reconstruction is superior to rehabilitation strategies for managing non-acute ACL injuries with persistent symptoms of instability.

However, there were two challenges — compare Performed in the Netherlands, canon A study conducted in Sweden found that early surgery was equivalent to an initial rehabilitation strategy with the option of delaying ACL surgery if necessary.

What will happen in the long run?

Post-traumatic OA is a well-known long-term consequence of ACL injury.according to Recent meta-analysisthe risk of OA increases sevenfold when comparing people with and without an ACL injury.

ACL injuries also cause OA to occur at an earlier age than OA patients without ACL injuries. This has been shown to progress at a faster rate and be associated with longer duration of disability, Philbey said.

But can ACL really be cured? Philbey thinks so, and has been involved in several studies using MRI to examine how the ACL becomes this way.

in recently published papers, Filbay et al. reported the results of a secondary analysis of the KANON trial, showing that nearly one in three (30%) of participants randomized to any delayed surgery had a positive outcome at two years. I discovered that I had MRI evidence. However, when excluding those who had delayed surgery, there was evidence of cure in 53% of those who managed with rehabilitation alone.

This evaluation also found that when using the Knee Injury and Osteoarthritis Outcome Score (KOOS), those with healed ligaments and those with unhealed ligaments had better outcomes, and those with healed ACLs performed better than those with healed ligaments. We also found that two-year outcomes were better in people with early or cured disease. ACL surgery was delayed.

ACL continuity and long-term outcomes

At OARSI 2024, Philbey and colleagues reported further long-term study results. Secondary analysis of KANON study Regarding the relationship between ACL healing after 5 years and outcome after 11 years. The results were: first reported in NEJM Records.

Filbay reported that participants with ACL continuity on MRI at 5 years actually had worse patient-reported outcomes at 11 years than participants managed with early or delayed ACL reconstruction Did.

“This is inconsistent with previous findings suggesting better two-year outcomes compared to the surgically managed group,” Philbey said.

However, those with persistent ACLs after rehabilitation appeared to have numerically similar or fewer radiographic signs of OA at 11 years of age compared with the surgical group.

Radiographic OA of the tibiofemoral joint (TFJ) or patellofemoral joint (PFJ) at 11 years was 14% and 21%, respectively, of those with persistent ACL (n = 14) at 5 years; and observed in 22% and 11%. The rehabilitation-only group experienced ACL disruption after 5 years.

By comparison, radiographic OA of the TFJ or PFJ at 11 years was 23% and 35%, respectively, in those who underwent delayed surgery and rehabilitation (n = 26) and 18% in those who underwent early surgery. and 41%. n = 49).

These are descriptive results, Philbey said, as the numbers are too small to perform statistical analysis. Additionally, large-scale, long-term studies will be needed.

Post-traumatic OA after ACL surgery

Elsewhere at OARSI 2024, Matthew HarkeyPh.D., and colleagues at Michigan State University in East Lansing, Michigan; Reported data It has been shown that nearly two-thirds of people who undergo surgical reconstruction exhibit symptoms that may indicate early knee OA at 6 months.

Knee symptoms indicative of OA decreased by 53% at 12 months and 45% at 24 months.

“This is a bit complicated. We cannot say for sure that the arthritis is progressing, but there are many patients whose symptoms persist long after surgery,” Harkey said in the paper. press release.

“Clinicians often believe that these post-operative symptoms will improve on their own as patients return to normal activities. However, from what we are seeing, these symptoms do not persist. “This suggests that a targeted approach is likely needed to manage or improve the situation,” Harkey said.

The analysis used data from 3,752 people aged 14 to 40 who enrolled in the program. New Zealand ACL Registry Those who completed KOOS 6, 12, and 24 months after ACL reconstruction.

Harkey et al. reported that 1 in 3 people had persistent early OA symptoms at 2 years, while 23% had no early OA symptoms at any time.

The research was independently supported. Philbey and Harkey had no relevant financial relationships to report.

Philbey and colleagues Assisting with treatment decisions For people with ACL injuries. This provides information about the different treatment options available and how they compare.