[Treatment and rehabilitation of anterior cruciate ligament injuries in Norway. A comparison with the Anterior Cruciate Ligament Study Group].

The method of treatment for ruptures of the anterior cruciate ligament range from nonoperative treatment through direct repair to complicated augmentation. The Anterior Cruciate Ligament (ACL) Study Group, consisting of orthopaedic surgeons from USA, Canada, Australia, Sweden, Austria and Switzerland, summarized its thoughts on treatment and rehabilitation in a recent paper. A survey has been carried out on Norwegian treatment practice and compared with the practice of the Anterior Cruciate Ligament Study Group. This paper describes the difference in treatment between the two groups of surgeons and reviews the methods of rehabilitation used for acute tears of the Anterior Cruciate Ligament Study Group. The majority of Norwegian surgeons in this study use primary repair with no augmentation, while surgeons in the Anterior Cruciate Ligament Study Group use augmentation methods allowing early mobilization and return to preinjury activities. 88% of the Norwegian surgeons prescribed a cast for six weeks after surgery, while only 15% of the surgeons in the Anterior Cruciate Ligament Study Group prescribe immobilization for more than four weeks. In the rehabilitation protocol the Anterior Cruciate Ligament Study Group emphasizes strength training of the hamstring in order to protect the Anterior Cruciate Ligament, at the same time preventing dynamic exercises of the quadriceps for the last 30 degrees of extension so as to prevent strain on the Anterior Cruciate Ligament. This policy was shared by less than 50% of the Norwegian surgeons.