Diermeier Theresa, Rothrauff Benjamin B, Engebretsen Lars, Lynch Andrew D, Ayeni Olufemi R, Paterno Mark V, Xerogeanes John W, Fu Freddie H, Karlsson Jon, Musahl Volker, Brown Charles H, Chmielewski Terese L, Clatworthy Mark, Villa Stefano Della, Ernlund Lucio, Fink Christian, Getgood Alan, Hewett Timothy E, Ishibashi Yasuyuki, Johnson Darren L, Macalena Jeffrey A, Marx Robert G, Menetrey Jacques, Meredith Sean J, Onishi Kentaro, Rauer Thomas, Rothrauff Benjamin B, Schmitt Laura C, Seil Romain, Senorski Eric H, Siebold Rainer, Snyder-Mackler Lynn, Spalding Tim, Svantesson Eleonore, Wilk Kevin E
Investigation performed at University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Orthop J Sports Med. 2020 Jun 24;8(6):2325967120931097. doi: 10.1177/2325967120931097. eCollection 2020 Jun.
Treatment strategies for anterior cruciate ligament (ACL) injuries continue to evolve. Evidence supporting best-practice guidelines for the management of ACL injury is to a large extent based on studies with low-level evidence. An international consensus group of experts was convened to collaboratively advance toward consensus opinions regarding the best available evidence on operative versus nonoperative treatment for ACL injury. The purpose of this study was to report the consensus statements on operative versus nonoperative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. There were 66 international experts on the management of ACL injuries, representing 18 countries, who were convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the scientific organizing committee and session chairs for the 3 working groups. Panel participants reviewed preliminary statements before 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. Ultimately, 80% agreement was defined a priori as consensus. A total of 11 of 13 statements on operative versus nonoperative treatment of ACL injury reached consensus during the symposium. Overall, 9 statements achieved unanimous support, 2 reached strong consensus, 1 did not achieve consensus, and 1 was removed because of redundancy in the information provided. In highly active patients engaged in jumping, cutting, and pivoting sports, early anatomic ACL reconstruction is recommended because of the high risk of secondary meniscal 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, nonoperative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability, or when episodes of giving way occur, anatomic ACL reconstruction is indicated. The consensus statements derived from international leaders in the field will assist clinicians in deciding between operative and nonoperative treatment with patients after an ACL injury.
前交叉韧带（ACL）损伤的治疗策略不断发展。支持ACL损伤管理最佳实践指南的证据在很大程度上基于低水平证据的研究。一个国际专家共识小组召开会议，共同朝着关于ACL损伤手术治疗与非手术治疗的最佳现有证据的共识意见迈进。本研究的目的是报告在2019年ACL共识会议黑豹研讨会上制定的关于ACL损伤手术治疗与非手术治疗的共识声明。有66位来自18个国家的ACL损伤管理国际专家，他们被召集并参与了一个基于德尔菲法达成共识的过程。拟议的共识声明由科学组织委员会和3个工作组的会议主席起草。专家小组参与者在会议前审查初步声明，并通过在线调查对声明提供初步同意意见和评论。会议期间，对每项声明进行了讨论和辩论，然后进行了最终投票。最终，事先将80%的同意率定义为达成共识。在研讨会上，关于ACL损伤手术治疗与非手术治疗的13项声明中有11项达成了共识。总体而言，9项声明获得一致支持，2项达成强烈共识，1项未达成共识，1项因所提供信息重复而被删除。在从事跳跃、急停和转身运动的高活动量患者中，建议早期进行解剖学ACL重建，因为延迟手术会导致继发半月板和软骨损伤的风险很高，尽管建议进行一段时间的渐进性康复以解决功能障碍并改善神经肌肉功能。对于希望恢复直线平面活动的患者，采用结构化、渐进性康复的非手术治疗是一种可接受的治疗选择。然而，当存在持续的功能不稳定或出现打软腿情况时，则需要进行解剖学ACL重建。该领域国际领先者得出的共识声明将有助于临床医生在ACL损伤后为患者决定手术治疗还是非手术治疗。
