From the Guidelines
Surgical reconstruction using autografts is the recommended treatment for moderate thickness tears in the anterior cruciate ligament (ACL), particularly in young and/or active patients, to improve patient outcomes and decrease ACL graft failure rate. When considering treatment options for a moderate thickness tear in the ACL, it is essential to weigh the benefits and risks of each approach. According to the American Academy of Orthopaedic Surgeons clinical practice guideline summary 1, autografts have potential benefits for graft ruptures/revision and functional scores, and surgeons should consider autograft over allograft to improve patient outcomes.
The treatment approach may involve:
- Conservative management, including rest, ice, compression, and elevation (RICE protocol) for the first 48-72 hours to reduce swelling and pain
- Physical therapy to restore range of motion, strengthen the quadriceps and hamstrings, and improve proprioception
- Pain management using NSAIDs like ibuprofen or naproxen for 1-2 weeks
- A hinged knee brace may be recommended during daily activities and sports
However, for athletes or individuals with significant knee instability, surgical reconstruction using autografts from the patellar tendon or hamstring tendons is the preferred treatment option, as it provides the best chance for full knee stability and return to athletic activities 1. The decision between conservative and surgical treatment depends on the patient's age, activity level, and degree of functional impairment. It is crucial to consider the patient's individual needs and preferences when making treatment decisions, as noted in the AAOS appropriate use criteria for treatment of anterior cruciate ligament injuries 1.
From the Research
Treatment Options for Moderate Thickness Tear in the Anterior Cruciate Ligament
- The treatment options for anterior cruciate ligament (ACL) rupture include rehabilitation as first-line treatment, ACL reconstruction (ACLR) and post-operative rehabilitation, and pre-operative rehabilitation followed by ACLR and post-operative rehabilitation 2.
- Conservative management is still a valid option for ACL rupture, and the decision to undergo surgical reconstruction should be based on individual patient factors, such as age, activity level, and associated lesions 3.
Rehabilitation Protocols
- Early-stage rehabilitation is crucial for successful outcomes after ACLR, and should focus on six main dimensions: pain and swelling, knee joint range of motion, arthrogenic muscle inhibition and muscle strength, movement quality/neuromuscular control, psycho-social-cultural and environmental factors, and physical fitness preservation 4.
- Postoperative rehabilitation protocols may include vibration training, open-chain and closed-chain exercises, electrical stimulation, postoperative bracing, and aquatic therapy 5.
Surgical Reconstruction and Autologous Periosteum Transplantation
- For patients with combined ACL rupture and localized deep cartilage defects, simultaneous ACL reconstruction and autologous periosteum transplantation may be a viable treatment option 6.
- This technique involves reconstructing the ACL with a bone-tendon-bone graft and anchoring the periosteum transplant to the underlying bone with suture anchors and fibrin glue, followed by a rigorous postoperative rehabilitation protocol 6.