Gk. Fitzgerald et al., A decision-making scheme for returning patients to high-level activity with nonoperative treatment after anterior cruciate ligament rupture, KNEE SURG S, 8(2), 2000, pp. 76-82
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.