Non-operative Care of the Patient with an ACL-Deficient Knee

The purpose of this review is to provide an update to the most objective, evidence-based path through a non-operative course of rehabilitation after anterior cruciate ligament injury for those hoping to return to pivoting and cutting sports.

Anterior cruciate ligament (ACL) injuries are prevalent in pivoting and cutting athletes with many of these patients electing to pursue surgical reconstruction in hopes of returning to prior levels of function. Despite many athletes pursing ACL reconstruction, some may elect to pursue a non-operative course of care. Success with this treatment plan should be defined as the ability to return to sport without subsequent giving way episodes. Identification of those most likely to successfully return to sport with a non-operative course begins with completion of an evidence-based screening tool. If the patient has no concomitant injury and successfully passes the screening, they may proceed to a systematic, evidence-based progression through rehabilitation. Finally, the patient must complete a return to sport program and meet appropriate objective criteria, prior to return to sport.