Non-surgical management and return to play of an anterior cruciate ligament rupture: A case report

Background: The rates of athletic anterior cruciate ligament rupture (ACLRu) and subsequent surgical reconstructions are on the rise. Given the associated sub-optimal return to play (RTP) and re-injury rates, alternative management strategies, such and non-operative management, are being increasingly explored. Research demonstrates that there may be a subset of patients with ACLRu, who will benefit from non-surgical management. Objectives: In this case report, we aim to detail the comprehensive management involved in a 26.5-week RTP program for an athlete whose ACLRu was rehabilitated without surgical reconstruction. Clinical features: The patient suffered a left knee injury resulting in mild knee pain and effusion, with mild stiffness at the end range of knee flexion. On further examination, a slight left knee strength deficit with positive anterior drawer and Lachman's tests were found consistent with ACLRu, which was confirmed with MRI. Interventions and outcomes: The patient was classified as an ACL deficient coper after an initial 8-week conservative rehabilitation approach to the injury. The patient completed their RTP protocol over a total of 26.5 weeks, inclusive of initial strength and neuromuscular control training, a gradual return to restricted non-competitive training, through to competitive unrestricted training and eventual RTP. The RTP was without incident, with the patient achieving sufficient limb strength and power symmetry (>90%), adequate patient-reported outcomes and psychological readiness score before RTP. Conclusion: In select sportspeople, the non-operative ACLRu management may represent a viable and accelerated management strategy for successful RTP. However, more detailed guidelines are needed to guide the RTP process.