Gk. Fitzgerald et al., Proposed practice guidelines for nonoperative anterior cruciate ligament rehabilitation of physically active individuals, J ORTHOP SP, 30(4), 2000, pp. 194-203
Nonoperative management of anterior cruciate ligament (ACL) rupture has not
been a successful option for those who participate in high-level physical
activity. However, there are instances when patients may want to attempt to
return to physically demanding activities with nonoperative rehabilitation
for an ACL injury. The purpose of this commentary is to describe guideline
s for nonoperative management of physically active individuals with ACL inj
uries who wish to return to preinjury levels of physical activity. The guid
elines are based on the results of 2 clinical studies that improved the ove
rall success of nonoperative management of physically active individuals wi
th ACL ruptures. A decision-making process for selecting appropriate candid
ates for nonoperative management (rehabilitation candidates) is described.
Individuals are classified as rehabilitation candidates if they have no con
comitant ligament or mensical damage associated with the ACL injury, have a
unilateral ACL injury, and meet all 4 of the following criteria: (1) timed
hop test score of 80% or more of the uninjured limb, (2) Knee Outcome Surv
ey Activities of Daily Living Scale score of 80% or more, (3) global rating
of knee function of 60% or more, and (4) no more than 1 episode of giving
way since the incident injury to the time of testing. Individuals meeting t
he criteria of a rehabilitation candidate undergo an intensive rehabilitati
on program before returning to high-level activity. The rehabilitation prog
ram consisting of lower extremity muscle strength training, cardiovascular
endurance training, agility and sport-specific skill training, and a traini
ng program using balance perturbations is described.