Table 2

Characteristics of studies comparing ACL reconstruction with non-operative treatment

Author (year)NJournalLOEMean time to ACLR (weeks)Intervention technique (s)Mean follow-up (mo)Rate of return to preinjury (or higher) levels of athletic activityNotes
Acute ACLRDelayed ACLRNon-operative treatment
Acute ACLR
Calvo et al (2015)1327AJSMIV15.2TP12789%n/aFour patients underwent revision surgery due to graft rupture. Wide treatment range of 0.5–17 months, subjects not broken down by time
Nikolaou et al (2011)1494KSSTAIV16TP3878%n/aFour revisions for graft rupture.
Treatment range of 0.2–10 months
Redler et al (2012)1518ArthroscopyIV15.6TP43100%n/a
Kocher et al (2007)1661JBJSIV15.2TP43100%n/aTwo patients experienced rerupture after returning to sports.
59/59 (100%) non-revision knees returned to cutting and pivoting sports.
Delayed ACLR
Cassard et al (2014)1728JPOIV59PTP (AE femur)34100%n/aTwo subjects sustained graft ruptures.
Cohen et al (2009)1826ArthroscopyIV21.6TP4588.8%n/aThree patients experienced rerupture
Seon et al (2005)1911JKMSIV16.8TP7890.9%n/a
Goddard et al (2013)2029AJSMIV28TP2486%n/aWide treatment range of 1 month to 6 years post injury. 2 patients (6%) sustained rerupture and were not included in the original study analysis. 86% of those included were involved in ‘strenuous’ or ‘very strenuous’ activities 24 months postoperatively
Aronowitz et al (2000)2119AJSMIV21.2TP2584%n/aAll of the patients were initially treated non-operatively with bracing until delayed surgery at age 14 years
Unspecified interval to ACLR or combined cohorts
McCarroll et al (1988)1060AJSMIV24TP50.491.7%0%Of the 38 patients initially treated non-operatively (delayed ACLR), 16 attempted to return to activity during the non-operative treatment and all were unsuccessful. 55 (91.7%) patients in the overall cohort returned to pre-injury levels of activity following ACLR, however were not stratified in the manuscript based on acute or delayed ACLR
Matava and Siegel (1997)278Am J Knee SurgIV(See notes)TP32100%100%n/aFour acute tears with an average of 5.5 weeks between the injury and ACLR and four patients with chronic tears (average of 29 weeks between injury and surgery). All patients returned to sports postoperatively
Edwards and Grana (2001)2520AJKSIVNRTP3495%n/aTwo graft ruptures occurred after return to sport
Shelbourne et al (2009)24402Sports HealthIVNRTP11887% basketball
90% soccer
n/aRate of return to soccer recalculated from study data
Hui et al (2012)2616AJSMIV(See notes)TP25100%n/aReconstruction was performed within 3 weeks of injury in 6%, between 3 weeks and 12 weeks in 50%, and after 12 weeks in 44%
McCullough et al (2012)2853AJSMIIINRBTB
Various Allograft
2445%n/aHigh school (freshman-junior) subcohort. Examined return to competitive football. Specific surgical techniques not reported
Ardern et al (2012)2943AJSMIIINRNR4049%n/aYouth subcohort of an age-comprehensive study. Retrospective case-series but designated as level III evidence
Demange and Camanho (2014)2212AJSMIVNRPTP (OTT femur)22083%n/aThree patients presented with sports-related reruptures. 41.6% of cohort returned to competitive sports and 41.6% who returned to recreational sports. No preoperative level of competition reported
Schmale et al
29CORRIVNRTP4841%n/aFour patients experienced rerupture
Mizuta et al
18JBJS Br.IVn/aNon-operative204n/an/a6%Of this non-operative study cohort, none returned to sports and six eventually required ACLR for recurrent instability
Moksnes et al (2013)3046BJSMIIn/aNon-operative12 and 24n/an/a52%Percentage returned reported at 1 year post injury. 22% of cohort underwent ACLR due to persistent instability; 19.5% underwent new symptomatic meniscal surgeries. 52% maintained ‘level 1’ sports participation at 1 year. Number who dropped down from less competitive levels not reported
  • ACLR, anterior cruciate ligament reconstruction; AE, all-epiphyseal ACL reconstruction; BTB, bone-patellar tendon-bone; NR, not reported; LOE, level of evidence; OTT, over the top femur; PTP, partial transphyseal (hybrid) ACL reconstruction; TP, transphyseal ACL reconstruction.