Guidelines for operative versus nonoperative management of anterior cruciate ligament injuries

Abstract

In this chapter, we summarize the existing evidence comparing operative and nonoperative treatment of anterior cruciate ligament (ACL) injury in skeletally mature athletes. We present a validated program of screening and rehabilitation for use in nonoperative treatment or when delaying ACL reconstruction for any reason. We concentrate on patients presenting after acute injury, because patients presenting with a symptomatic, chronically ACL-deficient knee are very likely to have a meniscus tear or chondral damage [4, 18, 48, 54] which will affect the function and evolution of the knee. Even today, among patients who are not evaluated promptly by a clinician knowledgeable about knee ligament injuries, an ACL tear may go undetected and present later due to ongoing or recurrent symptoms. These patients, who present with a symptomatic ACL-deficient knee, are much more likely to have symptomatic meniscal or chondral damage that requires treatment. In contrast, aside from the initial pain and swelling associated with acute ACL rupture, functional deficits and symptoms often are more subtle and activity specific when only the ACL has been injured.