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Centre for Evidence-
Based Medicine

Open ACL repair: Chance of returning to sport after surgery

Clinical Bottom Line

57% (95% CI 37 to 77%) chance of returning to sport 4 years after surgical repair of an isolated tear of the anterior cruciate

Citation

Andersson C, Gillquist J. Treatment of acute isolated and combined ruptures of the anterior cruciate ligament. Am J Sports Med 1992;20:7-12.

Clinical Question

In people who have had an open surgical repair to the anterior cruciate ligament, what are the chances of returning to strenuous sport?

Search Terms

Knee injuries (MeSH), anterior cruciate ligament repair (text word) combined with randomised controlled trials (MeSH), random allocation (MeSH) searched from 1988-1998

The Study

107 patients with acute knee injury examined by arthroscopy under anaesthesia. There were four groups: Group A included 24 patients with an isolated ACL tear that was repaired and augmented surgically. Group B included 31 patients with an isolated ACL tear that was not repaired. Group C included 24 patients who had an ACL tear combined with an MCL tear and both were repaired. Group D consisted of 28 patients with both ACL and MCL tears where only the MCL was repaired.

The Evidence

  • The Outcome: return to sport
  • Well-defined sample at uniform (early) stage of illness..?, yes;
  • Follow-up long enough..?, yes;
  • Follow-up complete..?, yes;
  • Blind and objective outcome criteria..?, no;
  • Adjustment for other prognostic factors..?, no;
  • Validation in an independent "test-set" of patients..?, no

The Evidence (for Group A)

Prognostic Factor Outcome Time Measure Confidence Interval
Isolated injury Return to sport 52 months 57% 37% to 77%
Combined injury Return to sport 52 months 50% 29% to 71%

If the pre-test probability is intermediate (e.g. 50%) then a positive clinical test would be helpful, yielding a post-test probability of 81%.

If the pre-test probability is low (e.g. 20 %) then the clinical test is not useful (post-test probability = 52%).

Comments

  1. Potentially important prognostic factors were not adjusted for.
  2. Outcome assessment was not blind.
  3. Allocation to groups was by alternation.
  4. The patients had surgery between 1980-1985 in Sweden. Given the dates of surgery and surgical technique, it is unclear if the results would be applicable to current standards of practice.

Appraised By

Chesworth and OBrien 1999

Expiry Date

2001

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