Comparison of Surgical and Non-Surgical Treatment of Anterior Cruciate Ligament Injury in Middle-Aged Population: A Prospective Cohort Study.

Background The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the human body. The main mechanism of injury is usually when a pivoting injury occurs in which the tibia is translated anteriorly. At the same time, the knee is in a slight valgus and flexed attitude, and is predominantly found in contact sports like soccer. The variable symptoms that warrant medical attention usually include pain, swelling, knee giving way, difficulty ambulating, and reduced knee range of motion. The treatment usually depends on the patient's symptomatology, type of injury, the growth remaining in his or her growth plates, and activity goals. The purpose of the study is to determine the superior treatment modality for ACL injury in patients older than 40 years. Methodology The study was a prospective study conducted in the orthopedic outpatient department of a tertiary care center in northern India. A total of 60 patients were included in the study sample. Patients were divided into two treatment groups: Group A (n=30), consisting of conservatively managed patients, and Group B (n=30), consisting of surgically managed patients. Various symptoms during presentation were also noted in the study, which showed pain and instability as the predominant symptoms on presentation. Treatment modalities for ACL injury in our study include conservative management by physiotherapy and surgical management with ACL reconstruction using a peroneus longus autograft. The physiotherapy protocol and post-surgery rehabilitation protocol were kept the same to compare the outcome in both groups. The Lysholm knee scoring scale was used to calculate the functional outcome of conservatively and surgically managed groups before intervention and post-intervention at the first, third, sixth, and twelfth months. The data was collected and summarized in Microsoft Excel (Microsoft Corp., Redmond, WA) and analyzed with IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp., using the ANOVA test, chi-square test, and paired t-test. A p-value of < 0.05 indicated a statistically significant difference. Results The study was conducted with two groups (group A: conservative; group B: surgical group) with comparable demographic profiles and slight male predominance, comparing the functional outcome of surgically and conservatively managed middle-aged patients with ACL injuries. The Lysholm knee scoring scale showed a poor pre-intervention score in both groups. This subsequently improved over a period of one year of study for both groups. After 12 months, a Lysholm Knee Score of 75.80±5.95 (group A) and 96.13±2.65 (group B), with a p-value of < 0.001, was noted, which showed a significantly superior functional outcome of surgical intervention in ACL injury as compared to conservative treatment in the study population. Conclusions Sixty patients over 40 years of age were taken up for the study, with more than two-thirds of the study population being male. The study showed the pre-intervention Lysholm knee scoring scale for both groups to be "poor." The score remained "poor" even after the first month post-intervention. After 12 months, a Lysholm Knee Score with an "excellent" outcome was noted in the surgical group (group B), which depicted an overall superior functional outcome of surgical intervention in ACL injury as compared to conservative treatment in the study population.