Non-operative management of a complete anterior cruciate ligament injury in an English Premier League football player with return to play in less than 8 weeks: applying common sense in the absence of evidence

Abstract

This case report illustrates and discusses the non-operative management of a complete anterior cruciate ligament (ACL) injury in an English Premier League football player, his return to play within 8 weeks and problem-free follow-up at 18 months post injury. When non-operative verses surgical ACL reconstruction is considered there are many fundamental gaps in our knowledge and currently, at elite level, there are no cases in cutting sports within the literature to guide these decisions. When the norm is for all professional footballers to be recommended surgery, it will be very challenging when circumstances and patient autonomy dictate a conservative approach, where prognosis, end points and risk are unclear and assumed to be high. This case challenges current dogma and provides a starting point for much needed debate about best practice, treatment options, research direction and not just at the elite level of sport.

Figure 1

Anterior cruciate ligament intact 1 year prior to injury.

Figure 2

Anterior cruciate ligament complete tear 1 day after the injury.

Figure 3

Anterior cruciate ligament still complete tear 10 months after injury.

Figure 4

No osteochondral injury 1 year prior to injury.

Figure 5

Osteochondral injury in lateral sulcus 1 day after Anterior cruciate ligamen injury.

Figure 6

10 months after injury the radiology report concludes that “the lateral femoral condyle osteochondral lesion has healed. The lateral tibial plateau chondral fibrillation adjacent to the posterior horn of the meniscus and femoral trochlea osteochondral lesions have not changed since post-injury MRI (figure 5). No new osteochrondral lesions or new meniscal injury seen.”