ACL Injury · Conservative vs Reconstruction

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Instability/demand + associated injury
   Activity demand/instability? Associated meniscal or multiligament injury?
   • Young/active, pivoting sports, giving-way instability, or repairable meniscus/multiligament → Active/unstable → arthroscopic reconstruction
   • Low-demand/sedentary, willing to modify activity, isolated, no significant instability → Low-demand → rehab (reconstruction can be delayed)
   • Acute locking (bucket-handle meniscus)/multiligament injury/neurovascular injury → Locking/multiligament → early surgery
2. [End] Low-demand → rehab (reconstruction can be delayed)
   Low-demand, willing to modify activity, isolated without instability → rehab-led (neuromuscular training, quadriceps strengthening); delayed reconstruction if instability persists (KANON: rehab ± delayed reconstruction has similar outcomes to early reconstruction).
3. [End] Active/unstable → arthroscopic reconstruction
   Young active/pivoting sports/persistent instability/repairable meniscus → arthroscopic ACL reconstruction (autograft hamstring/patellar tendon/quadriceps tendon, or allograft); reconstruction rather than primary repair.
4. [End] Locking/multiligament → early surgery
   Acute locking (incarcerated bucket-handle meniscus)/multiligament injury/associated neurovascular injury → early surgery (meniscal reduction-repair, multiligament reconstruction); manage vascular injury as an emergency.

Source guidelines & references

• ACL injury management (AAOS guideline; KANON trial early vs delayed reconstruction)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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