Multidisciplinary Discussion Around the Management of Anterior Cruciate Ligament (ACL) Ruptures

Anterior cruciate ligament (ACL) rupture is a functionally significant injury that requires individualized treatment, either surgical or conservative, guided by a multidisciplinary team. Although surgical reconstruction is often the default approach, recent evidence supports conservative management in selected patients without serious associated injuries. This review analyzed four randomized controlled trials, SNNAP, KANON, COMPARE, and Tsoukas et al., to compare outcomes of surgical and non-surgical treatment. The SNNAP trial reported higher KOOS scores in the surgical group (mean difference 7.9; p=0.0053), though not clinically significant. The surgical group also reported better subjective improvement and cost-effectiveness. The KANON trial found no significant difference in functional scores or complication rates at 2 and 5 years, but greater laxity and a 51% surgical crossover in the conservative group. COMPARE showed slightly better functional and quality-of-life scores in the surgical group, while Tsoukas et al. reported better IKDC scores and reduced laxity in the surgical group after 10 years. Overall, about 50% of patients initially managed conservatively required later surgery due to instability. Conservative treatment can be effective with structured rehabilitation, close monitoring, and proper patient selection. Identifying "Coper" patients, those without instability after rehabilitation, is critical to avoiding delayed surgery and secondary joint damage. Optimal management involves early rehabilitation, regular assessment, and clear communication among sports physicians, surgeons, and physiotherapists. Educating patients about both treatment options and reassessing them at three months ensures informed decisions and better long-term outcomes.