Appropriate Use Criteria

AUC Assumptions and Disclaimer

BEFORE THESE APPROPRIATE USE CRITERIA ARE CONSULTED, IT IS ASSUMED THAT: 

• Patient history, physical examination, and/or imaging are consistent with diagnosis of complete ACL tear.
• Patient has a primary ACL tear, not a recurrent tear or tear of prior ACL reconstruction/repair.
• The patient does not have significant multi-ligament injuries (grade 1-2 mcl injuries are not exclusion criteria).
• The patient is otherwise in good health, of age-appropriate mental status, and a good candidate for surgery.
• The patient does not have a periarticular knee fracture.
• The patient has no underlying significant mental illness.
• The surgeon is trained and capable of performing all operative techniques with equal effectiveness.
• The patient can participate and/or cooperate in physical therapy or rehabilitation.
• Before a patient undergoes surgery, they have achieved good quadriceps control, have minimal effusion, and have good range of motion. If not, surgery will be postponed until this occurs.
• 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.
• The facility has each type of implant/equipment available and capable support personnel.
• Regarding graft choices: neither bone nor patellar tendon should be placed across the physes.
• Arthritic changes discussed in this AUC are assumed to be from osteoarthritis or post traumatic arthritis and exclude inflammatory arthropathies.
• Arthritic changes in patients with open physes were removed due to clinical rarity.  
• Because the scope of this AUC is treatment of a primary isolated ACL tear, the presence of meniscal or chondral pathology will be considered as a factor for ACL treatment, however, treatment (repair, debridement, or excisions) of meniscus and chondral pathology will not be addressed.
• The level of athletic activity is based on the surgeon’s or health care providers interpretation of the activity level of the patient in question or based on patient reported activity measure.
• Instability is a subjective symptom.
• The presence of arthritis, meniscal, or chondral pathology is best determined via a combination of clinical exam and radiographic imaging.
• Graft options, when a reconstruction is recommended, is dependent on surgeon preference and is not addressed in this AUC.
• ACL repair may include biologic adjuncts or other forms of repair enhancement techniques.

 CONDITIONS NOT COVERED IN THIS AUC: 

• Tibial eminence fracture
• Re-tears of prior reconstructions
• Partial ACL injuries 

DEFINITIONS:

• Non-Operative Treatment: Including but not limited to Phased Supervised Physical Therapy, may or may not include bracing, activity modification.

DISCLAIMER 

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.