Prognosis
ACL injury used to be considered a career-ending injury for many athletes. However, with surgical reconstruction and proper physiotherapy, 41% to 92% of athletes are able to return to their pre-injury level of activity.[90] Despite a high success rate in terms of knee impairment-based function, a systematic review has found a relatively low rate of postoperative return to competitive sport following ACL reconstruction, thus suggesting that factors (e.g., psychological factors) other than normalisation of knee function may contribute to return-to-sport outcomes.[90]
Subjective and objective assessment of knee function and quality of life by patients and physicians generally show very favourable ratings after reconstruction. Ratings tend to be significantly lower for those who opt for non-surgical treatment. This is likely due at least in part to the increased risk of recurrent instability, meniscal tears, and a sense that the knee is untrustworthy.[102] Non-operative outcomes seem to be worse in skeletally immature and more active patients. However, for those who are able to rehabilitate well, make certain lifestyle modifications, and psychologically cope with their limitations, a non-operative approach can yield good outcomes.
Over time, it has been shown that up to 60% or more of people who have had an ACL tear will develop post-traumatic knee arthrosis. It is still unclear as to whether surgical reconstruction truly reduces this risk. However, ACL reconstruction has been shown to restore functional stability and decrease the rate of secondary meniscal injury, which theoretically protects against the development of arthrosis.[103]
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