Long-term effects of non-operative treatment of the anterior cruciate ligament rupture in young active adults – literature review

Uvod: Pretrganje sprednje križne vezi predstavlja eno izmed najpogostejših poškodb kolenskega sklepa, kljub temu pa so si mnenja strokovnjakov glede optimalne vrste zdravljenja tovrstne poškodbe še vedno deljena. V zadnjih letih je rekonstrukcija postala v večini zlato pravilo za zdravljenje pretrgane sprednje križne vezi pri mladi, aktivni populaciji. Neoperativna oblika zdravljenja pa naj bi bila bolj primerna za osebe, ki niso športno aktivne in jim poškodba ne predstavlja velikih težav. Namen: Namen diplomskega dela je na podlagi pregleda literature ugotoviti kakšne posledice dolgoročno pusti neoperativno zdravljenje pretrgane sprednje križne vezi, z glavnim poudarkom na radiološko zaznanih spremembah sklepnih površin in nivojem telesne dejavnosti po poškodbi. Metode dela: Uporabljena je bila metoda pregleda literature. Iskanje primernih virov je bilo opravljeno s pomočjo elektronskih zbirk podatkov na strani PubMed s kombinacijo naslednjih ključnih besed v angleškem jeziku: ACL copers, non-operative treatment of ACL injury, ACL injury AND non-operative treatment, conservative rehabilitation after ACL injury. Iskanje literature je bilo izvedeno decembra 2018 in časovno omejeno na vire, objavljene od januarja 2008 dalje. Rezultati: Skupno so bili v pregled literature vključeni 303 preiskovanci iz 5 raziskav. Njihova starost v času poškodbe je bila med 18 in 39 let. Do statistično značilne razlike v nivoju telesne dejavnosti je prišlo pri dveh raziskavah, od tega le v eni med operativno in neoperativno skupino. Razlika v pogostosti artroze kolen po dolgoročnem obdobju je bila statistično neznačilna med skupinama (operativna skupina: 16?80 %neoperativna skupina: 12?68 %). Razprava in zaključek: Glede na rezultate pregleda lahko trdimo, da so dolgoročni izidi operativnega zdravljenja pretrganja sprednje križne vezi primerljivi izidom neoperativne oblike. Moramo pa biti kritični do dejstva, da smo se omejili le na nivo telesne dejavnosti in pogostost artroze kolen, kar nam ne da celotne slike o stanju posameznika. Rezultati nam prav tako dajo kritični vpogled v pogosto zmotno mišljenje, da je rekonstrukcija potrebna za zagotovitev dobrih dolgoročnih izidov. Za lažjo primerjavo rezultatov, bi se bilo treba v prihodnje osredotočiti na več posledic pretrganja sprednje križne vezi in v raziskavo vključiti tudi oceno funkcijskega statusa.Introduction: Rupture of the anterior cruciate ligament is one of the most common injuries of the knee joint, despite that there is still controversy about which treatment is the most optimal. In recent years, reconstruction of the torn ligament has become the golden standard for treating young, active adults, while non-operative treatment is supposed to be suitable only for non-active people, who do not have many difficulties because of the injury. Purpose: The purpose of this diploma work is to find out what kind of consequences are caused by long-term non-operative treatment of the anterior cruciate ligament rupture, with the main focus on radiologically observed changes to articular surfaces and the level of physical activity after the injury. Methods: Our study is a literature review. The search for eligible studies was conducted with the help of the electronic database PubMed with the combination of the following key words: ACL copers, non-operative treatment of ACL injury, ACL injury AND non-operative treatment, conservative treatment after ACL injury. The literature search was done in December 2018 and was limited to the studies published after January 2008. Results: Alltogether 303 patients from 5 studies were included in the review. Their age at time of injury was between 18 and 39 years. A statistically significant difference was found for the level of physical activity in two studies, only one of which found a difference between the operative and the non-operative group. The difference in the incidence of osteoarthritis after a long-term period was non-significant between both groups (operative group: 16?80 %non-operative group: 12?68 %). Discussion and conclusion: Based on the results of our review, we can confirm that long-term outcomes after operative treatment of the anterior cruciate ligament rupture are comparable to those after non-operative treatment. But we have to be critical of the fact that our review focused only on the level of physical activity and the incidence of knee osteoarthritis, outcomes of which do not give us the whole picture of the patients health status. The results also offer us a critical insight into the commonly believed fact that a reconstruction surgery is needed to provide good long-term outcomes. In the future it would be necessary to focus on more consequences of anterior cruciate ligament rupture and also include measures of functional status into studies