title: Proximal anterior cruciate ligament tears: the healing response technique versus conservative treatment.
abstract: The healing response technique (HRT) is a nonreconstructive method to promote healing in proximal anterior cruciate ligament (ACL) tears. The study reviews clinical and radiological long-term results. Thirty patients (average age 31 years) were treated according to the protocol described by Steadman et al. For comparison, an age- and gender-matched control group of conservatively treated patients (CST; n = 127) was selected. At follow-up (mean: 4 years), all patients were evaluated using Kneelax-3-arthrometer, magnetic resonance imaging (MRI), and by clinical examination. Two HRT patients were lost to follow-up and 10 (36%) patients needed definitive ACL reconstruction. The rate of secondary ACL reconstruction in the initial CST group was 56% (71 of 127). Nineteen of the conservatively treated patients were selected according to above-mentioned criteria. The average Lysholm score in the HRT group was 91 (CST group = 90), and the Orthopaedische Arbeitsgemeinschaft Knie score was 93 (CST group = 92). Tegner score decreased from 6.8 before injury to 5.7 at the time of follow-up (CST group: 6.0 to 5.1). Kneelax-3-arthrometer showed a significant higher anterior knee laxity compared with the noninjured side in both groups. MRI showed improvement of the ACL in both groups. HRT in adult patients is associated with a high revision rate of 36% secondary ACL reconstruction, comparable with primary conservative treatment (p = 0.056). For the remaining patients (64%), HRT did not result in better outcomes than conservative treatment.
authors.affiliation: Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baden, Baden 5404, Switzerland. hanswasmaier@web.de
authors.forename: Johann
authors.initials: J
authors.lastname: Wasmaier
authors.forename: Rahel
authors.initials: R
authors.lastname: Kubik-Huch
authors.forename: Christian
authors.initials: C
authors.lastname: Pfirrmann
authors.forename: Holger
authors.initials: H
authors.lastname: Grehn
authors.forename: Christian
authors.initials: C
authors.lastname: Bieg
authors.forename: Karim
authors.initials: K
authors.lastname: Eid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016118:Anterior Cruciate Ligament / Q000473:pathology / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D053587:Arthrometry, Articular; D054544:Arthroplasty, Subchondral; D001182:Arthroscopy; D016022:Case-Control Studies; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000628:therapy*; D007719:Knee Joint / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D012372:ROC Curve; D016896:Treatment Outcome; D055815:Young Adult