New Guideline: Surgically Repair ACL Injury Within 5 Months

Larry Hand

September 23, 2014

The American Academy of Orthopedic Surgeons (AAOS) has released a new evidence-based practice guideline for treating anterior cruciate ligament (ACL) tears.

ACL tears commonly occur in athletes competing in sports, including soccer, football, and basketball.

Recommendations in the new guideline are intended to augment clinical judgment of healthcare providers in making decisions. The guideline is endorsed by the National Academy of Sports Medicine, American Orthopaedic Society for Sports Medicine, and National Athletic Trainers Association.

For patients who are candidates for surgery, the new guideline contains a recommendation to perform reconstructive surgery within 5 months of an ACL injury to protect the knee joint.

"In an active patient, if you wait too long to surgically repair the ACL, there is a risk for additional injury to the knee," Kevin Shea, MD, chair of the AAOS Clinical Practice Guideline on the Management of ACL Injuries work group, said in a news release. "Therefore, surgery within five months of injury may have some advantages. Nonsurgical treatment also is appropriate for some patients, including those with less active lifestyles who do not place significant demands on the knee."

Among other recommendations, the guideline says practitioners:

  • should take a "relevant history and perform a musculoskeletal exam of the lower extremities,"

  • should confirm ACL diagnosis and identify associated joint and cartilage problems through magnetic resonance imaging,

  • "might perform surgical reconstruction because it reduces activity related disability and recurrent instability which may lead to additional injury,"

  • "might repair these meniscus tears when combined with ACL reconstruction because it improves patient outcomes,"

  • might perform nonoperative reconstruction treatment in patients with recurrent instability,

  • may get better-measured outcomes in patients undergoing intra-articular ACL reconstruction by using either single-bundle or double-bundle technique, and

  • should use either patellar tendon or hamstring tendons in patients undergoing intra-articular ACL reconstruction with autograft tissue.

Other Guidelines

The AAOS also issued new clinical practice guidelines both for diagnosing and treating hip fractures in patients aged 65 years old and older and for developmental dysplasia of the hip in infants up to 6 months old.

"Management of Anterior Cruciate Ligament Injuries." American Academy of Orthopaedic Surgeons. Published online September 5, 2014. ACL guideline full text

"Management of Hip Fractures in the Elderly." American Academy of Orthopaedic Surgeons. Published online September 5, 2014. Hip fracture guideline full text

"Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age." American Academy of Orthopaedic Surgeons. Published online September 5, 2014. Hip dysplasia guideline full text


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