AAOS updates clinical guidelines for management of ACL injuries

Orthopedic

The American Academy of Orthopaedic Surgeons has issued an update to the clinical practice guideline for management of anterior cruciate ligament injuries, replacing the previous version released in 2014. 

This CPG provides updates to 12 of the 24 existing evidence-based recommendations and includes two new recommendations to treat patients who have been diagnosed with an ACL injury of the knee.

"These updates represent key learnings that are better understood through the recent literature and can serve as guidelines to care based on the specific patient and the situation," Kent Jason Lowry, MD, co-chair of the clinical practice guideline workgroup and member of the AAOS committee on evidence-based quality and value, said in a Sept. 7 news release. "However, they also highlight gaps where more research is needed to evolve and further define the guidelines to help surgeons and their patients make evidence-based decisions."

Certain recommendations were updated to account for the nuances related to skeletal maturity and activity level of the patient. Specifically, the committee recommends using an autograft instead of an allograft to improve patient outcomes and lower graft ruptures or revisions, particularly in young or active patients. The guidelines also include a moderate recommendation that when performing an ACL reconstruction with an autograft for skeletally mature patients, surgeons may favor the bone patellar bone as the tendon source to reduce the risk of graft failure or infection of the hamstring to reduce the risk of anterior or kneeling pain.

The updated CPG features two new recommendations:

1. A strong strength recommendation favoring ACL reconstruction over repair due to a lower rate of revision surgery when compared to ACL repair.

2. A moderate strength recommendation stating that, in select patients, anterolateral ligament/lateral extraarticular tenodesis could be considered when performing hamstring autograft reconstruction to reduce graft failure and improve short-term function.

Additional updates to the recommendations include:

1. Surgical timing for treatment of an acute isolated ACL tear is now recommended within three months of the injury, reduced from five months as stated in the previous edition, as early reconstruction is preferred because the risk of additional cartilage and meniscal injury starts to increase within three months.

2. Training programs designed to prevent injury can be used to reduce the risk of primary ACL injuries in athletes participating in high-risk sports.

3. Functional evaluation, such as the "hop" test, may be considered as one factor to determine return to sport after ACL reconstruction.

Click here to access the full CPG for management of ACL injuries.

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