Prognosis
ACL injury used to be considered a career-ending injury for many athletes. However, with surgical reconstruction and proper physical therapy, 41% to 92% of athletes are able to return to their preinjury level of activity.[91] 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 sports following ACL reconstruction, thus suggesting that factors (e.g., psychological factors) other than normalization of knee function may contribute to return-to-sport outcomes.[91]
Subjective and objective assessment of knee function and quality of life by patients and physicians generally show very favorable ratings after reconstruction. Ratings tend to be significantly lower for those who opt for nonsurgical 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.[104] Nonoperative outcomes seem 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 nonoperative 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 posttraumatic 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.[105]
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