Managed Physical Medicine

A Predictive Model for Conservative ACL Treatment – What the Workers’ Comp Industry Can Learn from a Sports Medicine Study

A new sports medicine study has identified early predictors of successful 2-year outcomes in those who opt for nonsurgical treatment of an anterior cruciate ligament (ACL) injury.

Conservative care (i.e., physical therapy) is becoming a more mainstream first-line treatment for many workers’ compensation injuries – but not all. Treatment plans must be designed to meet the needs of the injured worker, taking into consideration the severity of the injury and the circumstances of the patient, in order to achieve optimal outcomes.

This concept is not unique to the workers’ comp industry, and in one recent study of ACL-injured athletes in the Orthopaedic Journal of Sports Medicine, we see that by studying the outcomes of nonsurgical treatment – and the commonalities of the patients involved – practical models can be developed to better predict conservative care success.

The study’s participants were ACL-injured athletes who hailed from 2 sites: Oslo, Norway, and Delaware, USA. All participated in pivoting sports and none had significant related injuries. Demographic and knee function data were collected at baseline or after a 5-week neuromuscular and strength (NMST) rehabilitation program and were used to build multivariable logistic regression models.

After a 2-year period, 52 of 97 (53.6%) patients had a successful outcome, which was defined as having 2-year International Knee Documentation Committee (IKDC) scores ≥15th normative percentile and not undergoing ACL reconstruction. The study data suggest that clinicians can be more confident in nonsurgical treatment (i.e., active rehabilitation alone) in athletes who are female, are older in age and have good knee function. Through predictive models that incorporate knee function metrics from either before or after rehabilitation, 2-year prognoses for nonsurgical treatment can be estimated and aid in a shared decision-making process.

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Grindem, Hege, Elizabeth Wellsandt, Mathew Failla, Lynn Snyder-Mackler, and May Arna Risberg. “Anterior Cruciate Ligament Injury—Who Succeeds Without Reconstructive Surgery? The Delaware-Oslo ACL Cohort Study.” Orthopaedic journal of sports medicine 6, no. 5 (2018): 2325967118774255.