Conservative Treatment
There is limited evidence to support non-surgical management for less active patients with less laxity.

Rationale
This recommendation is based on one moderate-strength, one low strength and three very low strength studies .24, 31, 71, 93, 29 Patients were classified based on activity level and knee laxity at initial injury. The following three groups were considered particularly low risk: (1) Patients participating in less than 50 hours of jumping or cutting sports and less than 5 mm of side to side difference based on KT-1000 or manual maximal testing, (2) Patients participating in 50-199 hours of jumping or cutting sports with less than 5 mm of side to side difference based on KT-1000 or manual maximal testing, and (3) Patients participating in less than 50 hours of jumping or cutting sports with 5-7 mm of side to side difference based on KT-1000 or manual maximal testing.31 Collectively, these low risk groups were found to have lower rates of late meniscal surgery and ACL reconstruction than patients in the high risk groups treated non-operatively.31 Thus, low risk patients may do well with non-operative treatment. However, 25% of the low risk patients ultimately required surgery, including ACL reconstruction or meniscal surgery.31

Benefits of Implementation
Lower risk patients, based on activity and/or index laxity criteria, may tolerate an ACL deficient knee, and therefore may be spared exposure to the risks of surgical intervention such as infection, risks of anesthesia, arthrofibrosis, etc.

Possible Harms of Implementation
Despite being categorized as low risk, these patients may still require late ACL reconstruction and/or meniscal surgery and could sustain further damage to the ACL deficient knee

Future Research
Future research should attempt to define which patients may be safely treated conservatively after ACL injury, and what specific risk factors contribute to this decision making process.

 

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