Nonoperative Management of ACL Rupture

Abstract

Anterior cruciate ligament (ACL) reconstruction is common after ACL injury, particularly in young, active individuals. ACL reconstruction does not have universally good outcomes. Not all athletes will return to sport after ACL reconstruction (ACLR), and after reconstruction these individuals are at a high risk for second ACL injury and osteoarthritis. The best evidence suggests that ACLR is not necessary for everyone. This chapter will discuss the management of athletes after acute ACL rupture. Long- and short-term outcomes of operative and nonoperative management as well as determinants of success will be discussed. Athletes can return to their prior levels of sports without ACL reconstruction with progressive rehabilitation after ACL rupture. With recent evidence that outcomes after operative and nonoperative ACL injury management do not necessarily favor surgery, the authors recommend that athletes undergo a progressive physical therapy regimen that includes strengthening and neuromuscular training after ACL injury prior to the decision to undergo ACLR. If nonoperative management is elected as progressive, a criterion-based rehabilitation program culminating in a structured return to activity progression and battery of tests to determine readiness for return to sports should be employed.