The American Academy of Orthopedic Surgeons (AAOS) publish clinical practice guidelines for important and common orthopedic injuries to guide treatment based on the current and up to date scientific literature. Multidisciplinary clinician work groups come together to produce and provide these guidelines with a summary of the research used to support their recommendations. Most recently an AAOS work group updated the clinical practice guidelines for the treatment of anterior cruciate ligament tears. In particular there were several noted strong recommendations.
Several studies have demonstrated the benefit of early surgery over late reconstruction. While range of motion was not affected by early vs late reconstruction, in several studies patients undergoing late reconstruction showed more laxity of their knee in post-operative evaluation. Also patents undergoing late reconstruction had a higher incidence of further meniscal injuries and cartilage damage at the time of surgery. This can increase ones long term risk for osteoarthritis and impairment. The strong recommendation was performing an ACL reconstruction within 3 months of an acute ACL tear is feasible in most settings.
The work group also had a strong recommendation for the use of autograft, using a tendon or ligament from oneself to replace the ACL instead of donated tissue from a cadaver called allograft. Multiple studies have shown that autograft particularly in young and or active patients has lower graft rupture and revision rates. Additional benefits of autograft include lower cost and avoiding the risk of disease transmission (even though this is very low). Lastly but importantly, several studies have shown improved functional scores with autograft compared to allograft.
ACL repair (sewing back the torn ligament instead of replacing it) has been a hot topic in the orthopedic literature as several centers have pushed this new version of an older technique as a potential improvement in ACL surgery. The work group gave a strong recommendation for ACL reconstruction over repair due to lower retear and revision rates when comparing reconstruction to repair. They commented that while ACL repair research and technique continue to develop, ACL reconstruction is currently the standard of care.
The last strong recommendation in the guidelines was that single bundle and double bundle ACL reconstruction are both acceptable procedures for the reconstruction for the ACL deficient knee and both can result in excellent functional and clinical outcomes.
At Total Orthopedics and Sports Medicine our treatment and surgical procedures are based on the most up to date guidelines and research to optimize our patient’s outcomes and success.
American Academy of Orthopaedic Surgeons Management of Anterior Cruciate Ligament Injuries Evidence-Based Clinical Practice Guideline https://www.aaos.org/aclcpg Published August 22, 2022