Table 2

Consensus statements on non-operative and operative treatment of ACL injury

Agreed statementsAgreement
1Operative and non-operative treatments are both acceptable treatment options for ACL injury.100%
2Operative versus non-operative treatment should be reached via a shared decision-making process that considers the patient’s presentation, goals and expectations, as well as a balanced presentation of the available evidence-based literature.82.6%
3The (injury) status of other stabilising and supporting structures (eg, meniscus, other ligaments and cartilage) affects the decision to pursue operative or non-operative treatment.100%
4Individual anatomical differences (eg, tibial slope, femoral morphology and alignment) may affect the stability of the knee after ACL injury and should be considered in the decision-making process for operative versus non-operative treatment.95.7%
5After an ACL injury, patients may be offered a period of progressive rehabilitation to improve impairments and to improve overall function.100%
6Individuals presenting with instability in their desired activity despite optimal rehabilitation should be referred for operative treatment.100%
7Development of osteoarthritis after an ACL injury is multifactorial and evidence is inconclusive following operative or non-operative treatment.100%
8In active patients wishing to return to jumping, cutting and pivoting sports (eg, soccer, football, handball and basketball), operative treatment is the preferred option to maintain athletic participation in the medium to long term (1–5+ years after injury).100%
9In active patients wishing to return to jumping, cutting and pivoting sports (eg, soccer, football, handball and basketball), return to cutting and pivoting sports without surgery places the knee at risk of secondary injury (meniscus and cartilage).100%
11In active patients wishing to return to straight plane activities (eg, running, cycling, swimming and weightlifting), non-operative treatment is an option.100%
12In active patients wishing to return to straight plane activities (eg, running, cycling, swimming and weightlifting), in the case of persistent instability in daily life, operative treatment is appropriate for a return to non-rotational activities.100%
Not agreed statement
10In active patients wishing to return to cutting and pivoting sports (eg, soccer, football, handball and basketball), delayed operative treatment may be an option for temporary return to athletic participation following non-operative treatment accepting the risk of additional injury.43.4%
  • ACL, anterior cruciate ligament.