A decision-making scheme for returning patients to high-level activity with nonoperative treatment after anterior cruciate ligament rupture

This report describes the development and current use of decision-making cr iteria for returning patients to high-level physical activity with nonopera tive management of anterior cruciate ligament ruptures, and presents the re sults of treatment for patients who met our criteria as candidates for nono perative rehabilitation and attempted to return to high-level physical acti vity with nonoperative management. The screening examination consists of fo ur one-legged hop tests, the incidence of knee giving-way, a self-report fu nctional survey, and a self-report global knee function rating. We screened 93 consecutive patients with acute unilateral anterior cruciate ligament r upture, classifying them as either candidates (n = 39, 42%) or noncandidate s (n = 54, 58%) for nonoperative management. Of the 39 rehabilitation candi dates 28 chose nonoperative management and returned to preinjury activity l evels, 22 of whom (79%) returned to preinjury activity levels without Furth er episodes of instability or a reduction in functional status. No patient sustained additional articular or meniscal damage as a result of rehabilita tion or return to activity. The decision-making scheme described in this st udy shows promise in determining who can safely postpone surgical reconstru ction and temporarily return to physically demanding activities. Continued study to refine and further validate the decision-making scheme is recommen ded.