EARLY-SEASON ANTERIOR CRUCIATE LIGAMENT TEARS - A TREATMENT DILEMMA

An anterior cruciate ligament tear before or early in an athlete's sea son presents a treatment dilemma: surgically repair the ligament and e nd the season, or use rehabilitative exercises and bracing to quickly return the athlete to play. We conducted a prospective study of 43 ath letes (44 acute tears) over 44 months to determine criteria for early return to play and if an early return is safe, All patients had an acu te injury in a previously normal knee, a positive Lachman test, and KT -1000 arthrometry indicating ligament abnormalities, Magnetic resonanc e imaging of each injured knee showed an anterior cruciate ligament te ar but no meniscal tear, Thirty patients (31 tears) returned to play w ith rehabilitation and a brace at an average of 5.7 weeks after injury : Only 12 patients returned to their sports without recurrent buckling of their injured knees; 18 patients (19 knees) had recurrent buckling during play. Thirteen patients could not return to play, Patients wer e observed until they 1) had ligament reconstruction (29 patients, 29 tears), 2) gave up their sports because of instability but did not ele ct surgery (3 patients), or 3) returned to play in a brace and decline d surgery (11 patients, 12 tears), All who elected reconstruction expe rienced recurrent knee buckling, We found 23 meniscal tears (17 knees) in the 29 patients undergoing reconstruction.