Management overview for anterior cruciate ligament (ACL) tear

Discuss the natural history of ACL tear with the person, including their concerns, goals and expectations, and a proposed management plan including self-management.

People should be advised there are choices in the management of ACL tears, includingFrobell, 2010:

  • nonsurgical treatment with an option for surgery if there are ongoing problems (eg knee instability)
  • specific ‘prehabilitation’ (strengthening and range-of-movement therapy preoperatively) followed by surgery
  • early surgery followed by rehabilitation.

Decisions regarding nonsurgical versus surgical treatment rely on the patient’s goals and expectations, and the demands expected to be placed on the knee. The accepted strategies are:

  • surgical reconstruction of the ACL for young, active people who wish to place high demands on the kneeMonk, 2016Mall, 2016
  • nonsurgical management for less active people.

A small number of randomised controlled trials, comparing ACL reconstruction with nonsurgical management, showed no difference in patient-reported outcomesFrobell, 2010. Evidence indicates that surgical reconstruction of an ACL tear does not reduce the risk of developing osteoarthritis of the injured knee in the long termWebster, 2022Wellsandt, 2018van Yperen, 2018.

Note: Evidence indicates that surgical reconstruction of an anterior cruciate ligament (ACL) tear does not reduce the risk of developing osteoarthritis of the injured knee in the long term.