Nonoperative Treatment of Acute Anterior Cruciate Ligament Injuries in a Selected Group of Patients

Conservative treatment of acute anterior cruciate liga ment injuries was recommended to selected patients, including those with sedentary occupations, low athletic demands, or ages greater than 30 years. Patients with generalized hyperligamentous laxity were excluded. Fifty-five of 61 patients were available at an average followup of 46 months from the time of initial injury. At followup, giving-way symptoms had not occurred in 23 patients (42%); in 22 (40%) giving way occurred occa sionally. Of the 44 patients involved in high- or moderate-demand athletics, 33 (70%) were able to con tinue with moderate-demand sports. Presence of a me dial collateral ligament sprain did not affect the long- term function. Forty-eight percent of the patients scored excellent or good (9 and 18 patients, respectively) on the Hospital for Special Surgery ligament scoring sys tem ; 8 (15%) later chose surgical reconstruction. The remaining 47 patients did not believe that their symp toms were severe enough to warrant any further inter vention. In a group of individuals who are older and relatively inactive, nonoperative management of ante rior cruciate ligament injuries can yield satisfactory re sults, provided the patients are willing to accept a mod est amount of instability and a slight risk of meniscal injury.