Non-Operative ACL Management: Strategies and Considerations introduction Anterior cruciate ligament (ACL) rupture is a musculoskeletal knee injury that is common in sports and patients frequently undergo ACL...
Non-Operative ACL Management: Strategies and Considerations introduction Anterior cruciate ligament (ACL) rupture is a musculoskeletal knee injury that is common in sports and patients frequently undergo ACL reconstruction. There are often unrealistic expectations that prior knee function will be restored, prior activity levels attained, and further injury avoided. Unfortunately, these goals are not often achieved after ACL reconstruction.
Case Vignette A 33 year old recreational runner presents with right knee pain and swelling since an injury three days ago. He was helping a friend move and his knee twisted while carrying a couch. He had knee swelling initially that worsened the following day.
You examine him and his Lachman shows grade I laxity. He has not complained of any instability over the past few days. An MRI confirms your initial diagnosis of a full thickness ACL tear, but there was no meniscus tear or other ligament tear.
Which of the following is true? A) This should be a joint decision on solely operative management between provider and patient with balanced up to date information B) He is not a candidate for nonoperative treatment due to this injury C) A meniscus repair would be warranted along with an ACL reconstruction D) If he does not plan on playing any sports involving cutting or jumping, he may be a candidate for nonoperative management Both operative and nonoperative treatments of an ACL injury continue to evolve due to improved understanding of the structure and function of the native ACL and this has supported the development and adoption of anatomic ACL reconstruction techniques. In parallel, increased recognition of the resilience of the neuromuscular system in achieving dynamic, functional knee stability despite ACL deficiency has concurrently supported nonoperative treatment as a viable strategy in some patients.
ACL appears as a broad flat structure, shown here in the femoral notch, with its relations to the posterior cruciate ligament (PCL), medial femoral condyle (MFC), and lateral femoral condyle (LFC). These authors introduced the “rule of thirds,” which hypothesized as many as 1/3 of patients with ACL deficiency could function well with some level of pivoting and cutting activity without having functional instability or “giving way.” The other ⅔ would either function well only on the Activity of Daily Living Scale (ADLS) necessitating some level of activity modification or they would be unable to function at all with ACL deficiency due to instability. These patients would likely be indicated for surgical reconstruction.
If you are experiencing symptoms that may be related to nonoperative acl management, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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