Knee functional recovery following anterior cruciate ligament rupture : operative versus non-operative treatments

Abstract

Overview of the topic: Anterior cruciate ligament (ACL) ruptures are common knee injuries especially in pivoting sports. An ACL rupture will require some form of treatment. This study will focus on operative and non-operative treatments to manage and treat ACL ruptures. Furthermore, this study aims to determine the superior approach between these two types of treatment. For this reason, a research question based on the PICO framework was formulated as follows. The research question: In adults with anterior cruciate ligament ruptures, are operative interventions more effective than non- operative treatments for functional recovery? PICO elements: The targeted population were adults with ACL ruptures. The intervention chosen for this study are operative treatments, which was assessed along with non-operative treatments, set as the comparison. The outcome expected for this study is functional recovery. Method: The PICO elements were used to create alternative terms of the words. Boolean operators were used to combine the PICO elements and their alternative terms. Several combinations of the PICO elements and their alternative terms were constructed which were then inputted in the search databases to retrieve potential articles. Four databases were used to conduct the literature search including; HyDi, Scopus, PubMed and EBSCOhost. The following inclusion and exclusion criteria were adopted to ensure that relevant articles were chosen. This search strategy yielded a total of six articles, consisting of one meta-analysis, one systematic review, two randomised controlled trials and two cohort studies. These chosen articles were critically appraised using CASP tools. The chosen articles provide conflicting evidence as to which is the most effective treatment option. Furthermore, these articles do not provide a certain superior treatment approach between the two treatments. Although both treatment options may provide positive functional outcomes, more research must be conducted to determine the most effective treatment option. Recommendations for research, practice, education and management were addressed with consideration to the local context. Most importantly, the need for local research with a large number of participants was identified. Furthermore, incentives that the management may adopt to motivate local health-care workers to conduct research were also identified.