CME: Guidance for Managing ACL Injuries

CME: Guidance for Managing ACL Injuries

According to the American Academy of Orthopaedic Surgeons (AAOS), about 252,000 people in the United States suffer anterior cruciate ligament (ACL) injuries each year. ACL ruptures are typically the result of traumatic sports-related contact injuries, but they can also occur during non-contact activities. People who suffer ACL injuries are at higher risk for developing arthritis later in life. Studies indicate that women are two to eight times more likely to suffer an ACL injury than men. Several patient factors may affect the choice of treatment when managing ACL injuries. These include associated injuries that patients have experienced as well as comorbidities and skeletal maturity. Other characteristics like obesity, activities, and work demands can also play a role in treatment decision-making.   Navigating Complexities Recently, the AAOS released a clinical practice guideline (CPG) on the management of ACL injuries. The guideline recommends that reconstructive surgery occur within 5 months of an ACL injury to protect the knee joint, based on moderate supportive evidence. In addition, the CPG states that autografts are preferable over allografts to repair an ACL tear in adults aged 18 to 35. In 2015, the AAOS Board of Directors approved Appropriate Use Criteria (AUC) for ACL injury prevention programs and treatment. The AAOS also released AUC checklists on postoperative rehabilitation and function to help guide patients and physicians through treatment decisions and ensure that patients safely return to sports and physical activities. The AUCs, checklists, and links to a smartphone app are available for free online at www.orthoguidelines.org/auc. “Patients who suffer ACL injuries are a diverse group, and each individual will require a tailored treatment based on their...
Guidance for Managing ACL Injuries

Guidance for Managing ACL Injuries

According to the American Academy of Orthopaedic Surgeons (AAOS), about 252,000 people in the United States suffer anterior cruciate ligament (ACL) injuries each year. ACL ruptures are typically the result of traumatic sports-related contact injuries, but they can also occur during non-contact activities. People who suffer ACL injuries are at higher risk for developing arthritis later in life. Studies indicate that women are two to eight times more likely to suffer an ACL injury than men. Several patient factors may affect the choice of treatment when managing ACL injuries. These include associated injuries that patients have experienced as well as comorbidities and skeletal maturity. Other characteristics like obesity, activities, and work demands can also play a role in treatment decision-making.   Navigating Complexities Recently, the AAOS released a clinical practice guideline (CPG) on the management of ACL injuries. The guideline recommends that reconstructive surgery occur within 5 months of an ACL injury to protect the knee joint, based on moderate supportive evidence. In addition, the CPG states that autografts are preferable over allografts to repair an ACL tear in adults aged 18 to 35. In 2015, the AAOS Board of Directors approved Appropriate Use Criteria (AUC) for ACL injury prevention programs and treatment. The AAOS also released AUC checklists on postoperative rehabilitation and function to help guide patients and physicians through treatment decisions and ensure that patients safely return to sports and physical activities. The AUCs, checklists, and links to a smartphone app are available for free online at www.orthoguidelines.org/auc. “Patients who suffer ACL injuries are a diverse group, and each individual will require a tailored treatment based on their...
Guidelines for Managing ACL Injuries

Guidelines for Managing ACL Injuries

Anterior cruciate ligament (ACL) tears are among the most common injuries that occur in athletes participating in high-demand sports. Research has shown that people who suffer these injuries are at higher risk for developing arthritis later in life, and women are more likely to suffer an ACL injury with certain sports when compared with men. “Over 100,000 ACL injuries occur each year in the United States,” says Kevin G. Shea, MD. “These injuries are typically treated with surgical reconstruction in young active people, but patients often are concerned about how well they will be able to participate in sports and physical activities after surgery. They can also have a psychological and emotional impact on patients.” Key Recommendations Recently, the American Academy of Orthopaedic Surgeons (AAOS) released clinical practice guidelines (CPG) on the management of ACL injuries. The CPG strongly recommends that physicians obtain a relevant patient history and perform a musculoskeletal exam of the lower extremities when diagnosing ACL injuries. Use of knee radiographs and MRI may be useful for some patients for evaluation of these injuries. Another important issue is the timing of treatment, according to the CPG. “In appropriate candidates, reconstructive surgery may best be performed within 5 months of an ACL injury,” says Dr. Shea, who chaired the AAOS work group that developed the guidelines. “Active patients who wait too long to have their ACL surgically repaired are at risk for additional injury to the knee.” He adds that non-surgical treatment may be appropriate for some patients, including those who are less active or who do not place significant demands on their knee. An appropriate rehab...