A COMPARISON OF CONSERVATIVE AND DELAYED SURGICAL-TREATMENT OF ANTERIOR CRUCIATE LIGAMENT RUPTURES - A MATCHED-PAIR ANALYSIS

A series of 60 matched and paired patients with complete rupture of th e anterior cruciate ligament (ACL) was studied; 30 were treated conser vatively, even though operation was recommended, and 30 were operated on within 35 months (range 18 to 48 months) after the ACL rupture. The average age was 34 years in each group. They were assessed 39 months after arthroscopy or reconstruction. At follow up, no patient had flex ion of less than 100 degrees, 13 of the reconstructed knees had an ext ension deficit but in only one was this more than 10 degrees. Thirty-s ix percent of the reconstructed and 14% of the conservatively treated patients graded their sports activity as unlimited, while 13% of the A CL reconstructions and 21% of those treated conservatively were severe ly limited The Lysholm, Cincinnati and OAK scores were significantly b etter in the reconstructions. The anterior drawer sign was positive in 24% of the ACL reconstructions and in 81% of the conservatively treat ed patients; 19% had a positive pivot shift after reconstruction compa red to 75% of those treated conservatively. Even though there was a co nsiderable number of patients with a decreased range of motion after A CL reconstruction because of the slow regime of postoperative mobilisa tion used, the results of operation are significantly better than afte r conservative treatment even when ACL reconstruction was carried out late after injury.