AUC Assumptions and Disclaimer
1.Patient history, physical examination, and/or imaging are consistent with diagnosis of complete ACL tear.
2.Patient has primary ACL tear, not a recurrent tear.
3.Patient does not have significant multi-ligament injuries (grade 1-2 mcl injuries are not exclusions).
4.Patient is otherwise in good health and good candidate for surgery.
5.Patient does not have a periarticular knee fracture.
6.The surgeon is trained and capable of performing all operative techniques with equal effectiveness.
7.Patient able to participate and/or cooperate in physical therapy or rehabilitation.
8.The physician has an informed discussion with the patient about the treatment options and that the optimum treatment options may change over time for the patient. Before operative intervention is recommended, the appropriateness and potential efficacy of non-operative intervention has been considered.
9.Before a patient undergoes surgery they have achieved good quad control, have minimal effusion, and good range of motion. If not, surgery will be postponed until this occurs.
10.The surgeon will perform the surgery in the most appropriate location (i.e., ASC, outpatient, inpatient) based on the health of the patient and associated injuries.
11.The facility has each type of implant/equipment available and capable support personnel.
12.Regarding graft choices: neither bone nor patellar tendon should be placed across the physes.
13.A failed optimal nonoperative measure is defined as: patient has received optimal care and has received symptoms of recurrent instability. Nonoperative measures include: bracing, activity modification, and rehabilitation/physical therapy. 14.Arthritic changes discussed in this AUC are assumed to be from osteoarthritis or post traumatic arthritis and exclude inflammatory arthropathies. 15.Arthritic changes in patients with open physes were removed due to clinical rarity
Conditions Not Covered by this AUC
- Tibial eminence fracture
- Additional ligament injuries beyond an incomplete MCL injury
- Re-tears of prior reconstructions
- Partial ACL injuries
Volunteer physicians from multiple medical specialties created and categorized these Appropriate Use Criteria. These Appropriate Use Criteria are not intended to be comprehensive or a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. These Appropriate Use Criteria represent patients and situations that clinicians treating or diagnosing musculoskeletal conditions are most likely to encounter. The clinician’s independent medical judgment, given the individual patient’s clinical circumstances, should always determine patient care and treatment. Practitioners are advised to consider management options in the context of their own training and background and institutional capabilities when selecting recommended treatment options