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Nonoperative management of anterior cruciate ligament (ACL) rupture has not been a successful option for those who participate in high-level physical activity. However, there are instances when patients may want to attempt to return to physically demanding activities with nonoperative rehabilitation for an ACL injury. The purpose of this commentary is to describe guidelines for nonoperative management of physically active individuals with ACL injuries who wish to return to preinjury levels of physical activity. The guidelines are based on the results of 2 clinical studies that improved the overall success of nonoperative management of physically active individuals with ACL ruptures. A decision-making process for selecting appropriate candidates for nonoperative management (rehabilitation candidates) is described. Individuals are classified as rehabilitation candidates if they have no concomitant ligament or mensical damage associated with the ACL injury, have a unilateral ACL injury, and meet all 4 of the following criteria: (1) timed hop test score of 80% or more of the uninjured limb, (2) Knee Outcome Survey Activities of Daily Living Scale score of 80% or more, (3) global rating of knee function of 60% or more, and (4) no more than 1 episode of giving way since the incident injury to the time of testing. Individuals meeting the criteria of a rehabilitation candidate undergo an intensive rehabilitation program before returning to high-level activity. The rehabilitation program consisting of lower extremity muscle strength training, cardiovascular endurance training, agility and sport-specific skill training, and a training program using balance perturbations is described.

Proposed Practice Guidelines for Nonoperative Anterior Cruciate Ligament Rehabilitation of Physically Active Individuals