Intervention Review

Surgical versus conservative interventions for anterior cruciate ligament ruptures in adults

  1. Eric Linko1,*,
  2. Arsi Harilainen2,
  3. Antti Malmivaara3,
  4. Seppo Seitsalo4

Editorial Group: Cochrane Bone, Joint and Muscle Trauma Group

Published Online: 20 APR 2005

Assessed as up-to-date: 6 FEB 2005

DOI: 10.1002/14651858.CD001356.pub3


How to Cite

Linko E, Harilainen A, Malmivaara A, Seitsalo S. Surgical versus conservative interventions for anterior cruciate ligament ruptures in adults. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD001356. DOI: 10.1002/14651858.CD001356.pub3.

Author Information

  1. 1

    Diacor Hospital, Orthopaedic Department, Helsinki, Finland

  2. 2

    ORTON Orthopaedic Hospital, Knee and Sports Medicine Department, Helsinki, Finland

  3. 3

    Finnish Office for Health Care Technology Assessment, Occupational Medicine, Helsinki, Finland

  4. 4

    ORTON Orthopaedic Hospital, Department of Orthopaedics, Helsinki, Finland

*Eric Linko, Orthopaedic Department, Diacor Hospital, Alppikatu 2, Helsinki, FIN-00530, Finland. eric.linko@welho.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 APR 2005

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Резюме на простом языке

Background

Anterior cruciate ligament rupture is a common knee injury. Surgical treatment, usually involving reconstruction of the ligament, is widely used especially in active individuals.

Objectives

Evaluation of the effect of surgical treatment compared with conservative treatment of anterior cruciate ligament (ACL) rupture.

Search methods

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to January Week 3 2005), EMBASE (1988 to 2005 Week 05), MEDIC (1978 to January 1999), Current Contents (9.2.1998 to 1.2.1999), BIOSIS (1970 to December 1998), reference lists of articles and consulted trialists and experts.

Selection criteria

All randomised and quasi-randomised trials that compared surgical with conservative treatment of ACL rupture in adults.

Data collection and analysis

Two authors independently performed study selection, data extraction and quality assessment.

Main results

Two poor quality randomised trials conducted in the early 1980s were included in the review. The two trials differed considerably and no data pooling was done for the few shared outcome measures.

One quasi-randomised trial of 167 people with a complete ACL rupture treated with repair or augmented repair versus conservative treatment found no difference in the return to sports activities between people treated surgically and those treated conservatively. Measures of knee stability and functional (Lysholm) knee scores were higher in surgically-treated participants. By the end of the follow-up period (average 55 months), three people treated with repair only and 16 treated conservatively had had ACL reconstruction.

The other trial included 157 people with ACL injury. This found that conservatively-treated participants recovered from their injury more rapidly but, at the last follow up (minimum 13 months), the functional outcome was similar in both treatment groups. A large proportion of participants experienced some temporary discomfort after surgery and there were some more serious postoperative complications. There was less knee instability in surgically-treated participants and a tendency to fewer subsequent operations in the longer term.

Authors' conclusions

There is insufficient evidence from randomised trials to determine whether surgery or conservative management was best for ACL injury in the 1980s, and no evidence to inform current practice. Good quality randomised trials are required to remedy this situation.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Резюме на простом языке

Surgery versus conservative treatment to repair knee anterior cruciate ligament tears (ruptures) in adults

Anterior cruciate ligament (ACL) rupture is a common knee injury that often results in an unstable knee. Surgical treatment, usually involving reconstruction of the ligament, is widely used especially in active individuals. This review identified two randomised trials (324 people) testing outdated treatment methods. Surgical repair or augmented repair of the ligament gave better knee stability during daily activities and strenuous activities than non-surgical treatment. Functional recovery was similar with both treatments. Fewer people, however, went on to have a knee reconstruction or other knee additional surgery within the 13 to 55 months after surgical repair than following conservative treatment. No long-term information on development of arthritis was available. Overall, these studies presented some evidence that conservative treatment (immobilization, knee braces, physiotherapy) often gave acceptable recovery results. We found no randomised trials comparing modern methods of surgery with current methods of non-surgical treatment for these injuries.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Резюме на простом языке

背景

成人前十字韌帶的手術治療與保守治療的比較

前十字韌帶斷裂是一種常見的膝關節損傷.手術治療,通常包含韌帶的重建,是廣為人所使用的方式,特別在活動力旺盛的人身上.

目標

評估關於前十字韌帶的手術治療和保守治療的效果

搜尋策略

我們搜尋的資料庫如下, the Cochrane Musculoskeletal Injuries Group Specialised Register (January 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to January Week 3 2005), EMBASE (1988 to 2005 Week 05), MEDIC (1978 to January 1999), Current Contents (9.2.1998 to 1.2.1999), BIOSIS (1970 to December 1998), reference lists of articles,參考文獻,訪問的受試者以及專家如參考文獻出處所列.

選擇標準

所有比較成人前十字韌帶斷裂的手術及保守治療的隨機及半隨機試驗

資料收集與分析

2位作者各自獨立執行研究選擇,資料蒐集,以及品質評估

主要結論

2個在1980年代早期所做的品質不佳的隨機試驗被包含在這篇文章當中.這2個試驗彼此差異性很大,而且因為分享的結果評估方式非常少,因此並沒有做資料的統整.1個半隨機試驗,其中包括了167位前十字韌帶完全斷裂而接受修補或是補強手術的患者,和保守治療比較之下,在恢復到原本的體育活動的時間並無顯著差異.測量膝蓋穩定度以及功能性量表(Lysholm)的結果,在接受手術的受試者得到的分數較高.追蹤的尾聲(平均55個月),3位只接受修補和16位接受保守治療的患者接受了前十字韌帶的重建手術.另一個包含了157位前十字韌帶受傷患者的試驗中發現,保守治療下的患者恢復比較快,但是在追蹤的尾聲(最少13個月),功能的恢復在兩種治療方式之間是類似的.有很大一部分接受手術的受試者,在手術之後感覺暫時的不適,而另外則還有一些更嚴重的術後併發症.在手術治療之後的受試者有較少的膝蓋不穩定以及在長期來說較少的後續的手術.

作者結論

在1980年代的隨機試驗,並沒有足夠的證據可以確定對於前十字韌帶損傷而言,是手術治療還是保守治療較好,並且沒有證據可以提供資訊給最近的臨床實作.還需要好的隨機試驗來提供給目前的治療.

翻譯人

本摘要由臺灣大學附設醫院謝忠佑翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於成人前十字韌帶破裂(斷裂)的手術修補及保守治療的比較.前十字韌帶斷裂是一種常見的膝關節損傷,時常會導致膝關節的不穩定.手術治療,通常是包含了韌帶的重建,是被廣泛的使用,特別在活動力旺盛的人身上.這篇文章確認了2個測試過時的治療方式的隨機試驗(324位患者).手術修補或是補強韌帶比較非手術治療,可以提供日常的活動較佳的膝關節穩定性.功能的恢復則在兩種治療上是類似的.在手術治療後追蹤13到55個月的結果發現,與保守治療比較之下,手術治療這群患者當中,之後需要接受重建或是更多額外的膝蓋手術的人數較少.關於發展成關節炎的資料則缺乏長期的資訊.大體而言,這些研究提供了一些證據說明,保守治療(固定,膝關節護具,物理治療)常可以提供可接受的恢復程度.我們並沒有發現目前有關於比較現代手術治療方式以及現代非手術治療方式的隨機試驗.

 

Резюме на простом языке

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要
  5. Резюме на простом языке

Хирургическое лечение против консервативного для восстановления надрывов (разрывов) передней крестообразной связки колена у взрослых

Разрыв передней крестообразной связки (ПКС) является распространенной травмой колена, что часто приводит к нестабильности колена. Хирургическое лечение, как правило, с использованием реконструкции связки, широко используется, особенно у активных людей. Этот обзор включил два рандомизированных исследования (324 человека), протестировавших устаревшие методы лечения. Хирургическое исправление или расширенное исправление связки давало лучшую стабильность колена во время повседневной и напряженной деятельности, чем нехирургическое лечение. Функциональное восстановление было сходным после обоих видов лечения. Однако, меньшему числу людей потребовались реконструкция колена или дополнительные операции на колене в период от 13 до 55 месяцев после хирургического исправления, чем после консервативного лечения. Информации о развитии артрита при долгосрочном наблюдении не имеется. В целом, эти исследования представили некоторые доказательства того, что консервативное лечение (иммобилизация, наколенники, физиотерапия) часто давало приемлемые результаты восстановления. Мы не нашли рандомизированных исследований, сравнивающих современные хирургические методы с современными методами нехирургического лечения этих травм.

Заметки по переводу

Перевод: Гамирова Римма Габдульбаровна. Редактирование: Зиганшина Лилия Евгеньевна. Координация проекта по переводу на русский язык: Казанский федеральный университет. По вопросам, связанным с этим переводом, пожалуйста, свяжитесь с нами по адресу: lezign@gmail.com