Anterior cruciate ligament injury – who succeeds without reconstructive surgery? The Delaware-Oslo ACL cohort study

Review written by Dr Christina Le info

Key Points

  1. Older, female patients with good knee function early after an ACL tear have higher odds of reporting favorable symptoms and function in sports 2 years after injury.
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Patients can choose between two treatment options following an anterior cruciate ligament (ACL) tear: surgical or non-surgical management. Previous research shows that 52-56% of active patients who manage their ACL tear non-surgically have successful 2-year outcomes, roughly 33-37% eventually undergo delayed ACL reconstruction, and 11% remain ACL deficient and report poor knee function (1). There is a need for more research on what variables are associated with favorable outcomes for patients who choose non-surgical management of an ACL tear.

The primary objective of this longitudinal study was to identify variables that could predict a successful 2-year outcome in patients who managed their ACL tear non-surgically. The study also examined if prediction models would be different before and after a 5-week rehabilitation program.

52-56% of active patients who manage their ACL tear nonsurgically have successful 2-year outcomes.
We should consider a patient’s age, sex, single-leg hop LSI, and self-reported symptoms and function when engaging in the shared-decision making process of choosing surgical or non-surgical ACL management.


This study examined the patients in the Delaware-Oslo ACL Cohort who had not undergone ACL reconstruction by the 6-month follow-up. The study sample included 49 patients from Delaware and 69 from Oslo who sustained a unilateral ACL tear and previously

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