title: A Comparison of Operative and Nonoperative Treatment of Anterior Cruciate Ligament Injuries.
abstract: Intention to resume high-risk sports activity is a major motivating factor for patients who elect anterior cruciate ligament (ACL) reconstruction rather than nonoperative treatment. Some patients are able to cope with an ACL-deficient knee and resume preinjury activity levels, including level-1 sports (football, basketball, soccer, etc.), following nonoperative treatment; however, activity levels correlate with injury risk in ACL-deficient knees. Patients who have an ACL injury along with concomitant meniscal injury are at increased risk for osteoarthritis. It is unclear what effect reconstruction of an isolated ACL injury has on future osteoarthritis risk in ACL-deficient patients who are identified as "copers." There are distinct biomechanical differences between copers and noncopers, but no reliable screening tools are currently able to predict which patients will become copers following nonoperative treatment of an ACL injury. A trial of nonoperative treatment, including perturbation exercises, to determine whether reconstruction is needed does not increase the risk of additional knee injury.
authors.affiliation: Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Secrist
authors.affiliation: Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Frederick
authors.affiliation: Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Fotios P
authors.initials: FP
authors.lastname: Tjoumakaris
authors.affiliation: Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Stache
authors.affiliation: Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Sommer
authors.initials: S
authors.lastname: Hammoud
authors.affiliation: Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Freedman
mesh_terms: D016118:Anterior Cruciate Ligament; D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint; D010003:Osteoarthritis; D012306:Risk