Non-surgical management and return to play of an anterior cruciate ligament rupture: A case report

Abstract

BackgroundThe rates of athletic anterior cruciate ligament rupture (ACLRu) and subsequent surgical reconstructions are on the rise. Given the associated sub-optimal return to play (RTP) and re-injury rates, alternative management strategies, such and non-operative management, are being increasingly explored. Research demonstrates that there may be a subset of patients with ACLRu, who will benefit from non-surgical management. ObjectivesIn this case report, we aim to detail the comprehensive management involved in a 26.5-week RTP program for an athlete whose ACLRu was rehabilitated without surgical reconstruction. Clinical featuresThe patient suffered a left knee injury resulting in mild knee pain and effusion, with mild stiffness at the end range of knee flexion. On further examination, a slight left knee strength deficit with positive anterior drawer and Lachman's tests were found consistent with ACLRu, which was confirmed with MRI. Interventions and outcomesThe patient was classified as an ACL deficient coper after an initial 8-week conservative rehabilitation approach to the injury. The patient completed their RTP protocol over a total of 26.5 weeks, inclusive of initial strength and neuromuscular control training, a gradual return to restricted non-competitive training, through to competitive unrestricted training and eventual RTP. The RTP was without incident, with the patient achieving sufficient limb strength and power symmetry (>90%), adequate patient-reported outcomes and psychological readiness score before RTP. ConclusionIn select sportspeople, the non-operative ACLRu management may represent a viable and accelerated management strategy for successful RTP. However, more detailed guidelines are needed to guide the RTP process.