Treatment after ACL injury: Panther Symposium ACL Treatment Consensus Group

Abstract

Treatment strategies for ACL injuries continue to evolve. Evidence supporting best practice guidelines to manage ACL injury is largely based on studies with low-level evidence. An international consensus group of experts was convened determine consensus regarding best available evidence on operative versus non-operative treatment for ACL injury. The purpose of this study is to report the consensus statements on operative versus non-operative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. Sixty-six international experts on the management of ACL injuries, representing 18 countries, convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the Scientific Organising Committee and Session Chairs. Panel participants reviewed preliminary statements prior to the meeting and provided initial agreement and comments on the statement via online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Eighty per cent agreement was defined a priori as consensus. A total of 11 of 13 statements on operative versus non-operative treatment of ACL injury reached consensus during the Symposium. Nine statements achieved unanimous support, two reached strong consensus, one did not achieve consensus, and one was removed due to redundancy in the information provided. In highly active patients engaged in jumping, cutting and pivoting sports, early anatomical ACL reconstruction is recommended due to the high risk of secondary meniscus and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight plane activities, non-operative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability, or when episodes of giving way occur, anatomical ACL reconstruction is indicated. The consensus statements derived from international leaders in the field may assist clinicians in deciding between operative and non-operative treatment with patients after an ACL injury. Level of evidence: Level V

Greater Psychological Readiness to Return to Sport, as Well as Greater Present and Future Knee-Related Self-Efficacy, Can Increase the Risk for an Anterior Cruciate Ligament Re-Rupture: A Matched Cohort Study

“…An anterior cruciate ligament (ACL) rupture is treated with rehabilitation with or without ACL reconstruction. 1 Unfortunately, a rupture of the reconstructed ACL, an ACL re-rupture, can occur and is regarded as definite treatment failure. Re-ruptures of the ACL occur a median of 20 months after primary reconstruction and the rates typically vary between 3 and 7%, 2,3 but they can be as high as 10% in younger athletes.…”

Folgen einer vorderen Kreuzbandruptur – Ein systematisches Umbrella-Review

“…Im erst kürzlich veröffentlichten Konsensus-Paper des Panther-Symposiums wird für Patienten, die in kniebelastenden Sportarten aktiv sind, grundsätzlich eine Rekonstruktion empfohlen [77]. Diese klare Aussage wird durch hohe Return-to-Sport-Zahlen nach einer operativen Versorgung genährt (83 %, gepoolte Daten unterschiedlicher Sportarten) [78].…”

To Reconstruct the Anterior Cruciate Ligament or Not? – Put into Panther Perspective

“…Recently, the Panther consensus paper was released, including healthcare professionals from different countries and healthcare systems. 4 The Panther consensus panel agreed 100% that both operative and non-operative care for ACL injury is acceptable 4 -so far so good. However, whether rehab first with optional delayed surgery is an acceptable approach was not clearly addressed, although tackled in high-level randomized controlled trials.…”

“…1,2 The Panther group disagreed on delayed operative care as an option for temporary return to athletic participation, following non-operative care and accepting the risk of additional injury. 4 According to the experts, the elite athlete competing in pivoting sports needs a reconstruction 4 -but despite lots of ACL research, we still only have Level 5 evidence from consensus. 4 Even if we as experts promote shared decisionmaking, 4 the expectations from younger athletes are already so high, 5 and the procedure offered so quickly, that it seems questionable if athletes are ready and receptive for grasping mean outcomes and return to sport odds.…”

“…4 According to the experts, the elite athlete competing in pivoting sports needs a reconstruction 4 -but despite lots of ACL research, we still only have Level 5 evidence from consensus. 4 Even if we as experts promote shared decisionmaking, 4 the expectations from younger athletes are already so high, 5 and the procedure offered so quickly, that it seems questionable if athletes are ready and receptive for grasping mean outcomes and return to sport odds. Can we expect them to make truly informed and thoughtful decisions in a few weeks?…”