Rohit Rajput - Senior Editor, Surgical Department
Date Published: April 1, 2023
In “Evidence of ACL healing on MRI following ACL rupture treated with rehabilitation alone may be associated with better patient-reported outcomes: a secondary analysis from the KANON trial” by Stephanie Rose Filbay et al., the authors discuss the potential benefits of using only rehabilitation for treatment of anterior cruciate ligament (ACL) rupture instead of reconstructive surgery, especially since the complexity of the physiology of the ACL makes creating a surgical graft quite challenging. The secondary analysis of 120 participants were assigned randomly to early reconstructive surgery or exercise-based rehabilitation alone with optional delayed surgery. The results of healing were assessed based on Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, which included pain, symptoms, activities of daily living, sport, and recreational function, at two and five year follow-ups with the participants. Although it was previously assumed that an ACL rupture could not spontaneously heal with just rehabilitation alone, there were no significant differences noted in the group that underwent early reconstructive surgery. Therefore, an ACL rupture doesn’t always have to be treated with surgery and instead non-operative rehabilitation can be considered in certain cases. Further research needs to be conducted on which characteristics in a patient correlate to surgery as opposed to rehabilitation for ACL rupture treatment.
The findings of this study are noteworthy as the field of surgery shifts towards a minimally invasive approach with advancements in robotic implementation and straying away from opioid administration for pain management. Essentially, the process in choosing a treatment should heavily consider quickest post-operation recovery. If a patient’s problem can heal without surgery, in this case looking at ACL rupture, that should be the first path considered. Of course, there are gaps in the evidence and limitations to every study, and this article is no different; factors like the small sample size and potential for selection bias in the random assignment to treatment groups limit the generalized application for a surgeon’s decision. However, looking past that, more research in non-surgical methods to treat the human body is necessary. Although some procedures will never be replaced without an incision or suture, efforts should be made where they can be. In America, especially, post-surgical painkiller usage, including opioids, has partially led to the problem of addiction to medical prescriptions. By avoiding surgery altogether where possible or using a less invasive method, such as non-operative rehabilitation, we can reduce this occurrence and perhaps use lighter painkillers or nerve blocks instead. In conclusion, although surgery may seem the most involved in treating the patient, many times doing less is more.
References:
Filbay, Stephanie Rose, et al. “Evidence of ACL Healing on MRI Following ACL Rupture Treated with Rehabilitation Alone May Be Associated with Better Patient-Reported Outcomes: A Secondary Analysis from the KANON Trial.” British Journal of Sports Medicine, 3 Nov. 2022, bjsm.bmj.com/content/early/2022/11/03/bjsports-2022-105473, https://doi.org/10.1136/bjsports-2022-105473. Accessed 9 Dec. 2022.
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