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. 2020 Jun 24;8(6):2325967120931097.
doi: 10.1177/2325967120931097. eCollection 2020 Jun.

Treatment After Anterior Cruciate Ligament Injury: Panther Symposium ACL Treatment Consensus Group

Theresa Diermeier  1 , Benjamin B Rothrauff  1 , Lars Engebretsen  1 , Andrew D Lynch  1 , Olufemi R Ayeni  1 , Mark V Paterno  1 , John W Xerogeanes  1 , Freddie H Fu  1 , Jon Karlsson  1 , Volker Musahl  1 ; Panther Symposium ACL Treatment Consensus Group; Charles H Brown Jr  1 , Terese L Chmielewski  1 , Mark Clatworthy  1 , Stefano Della Villa  1 , Lucio Ernlund  1 , Christian Fink  1 , Alan Getgood  1 , Timothy E Hewett  1 , Yasuyuki Ishibashi  1 , Darren L Johnson  1 , Jeffrey A Macalena  1 , Robert G Marx  1 , Jacques Menetrey  1 , Sean J Meredith  1 , Kentaro Onishi  1 , Thomas Rauer  1 , Benjamin B Rothrauff  1 , Laura C Schmitt  1 , Romain Seil  1 , Eric H Senorski  1 , Rainer Siebold  1 , Lynn Snyder-Mackler  1 , Tim Spalding  1 , Eleonore Svantesson  1 , Kevin E Wilk  1
Affiliations

Treatment After Anterior Cruciate Ligament Injury: Panther Symposium ACL Treatment Consensus Group

Theresa Diermeier et al. Orthop J Sports Med. .

Abstract

Treatment strategies for anterior cruciate ligament (ACL) injuries continue to evolve. Evidence supporting best-practice guidelines for the management of ACL injury is to a large extent based on studies with low-level evidence. An international consensus group of experts was convened to collaboratively advance toward consensus opinions regarding the best available evidence on operative versus nonoperative treatment for ACL injury. The purpose of this study was to report the consensus statements on operative versus nonoperative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. There were 66 international experts on the management of ACL injuries, representing 18 countries, who were convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the scientific organizing committee and session chairs for the 3 working groups. Panel participants reviewed preliminary statements before the meeting and provided initial agreement and comments on the statement via online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Ultimately, 80% agreement was defined a priori as consensus. A total of 11 of 13 statements on operative versus nonoperative treatment of ACL injury reached consensus during the symposium. Overall, 9 statements achieved unanimous support, 2 reached strong consensus, 1 did not achieve consensus, and 1 was removed because of redundancy in the information provided. In highly active patients engaged in jumping, cutting, and pivoting sports, early anatomic ACL reconstruction is recommended because of the high risk of secondary meniscal and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight-plane activities, nonoperative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability, or when episodes of giving way occur, anatomic ACL reconstruction is indicated. The consensus statements derived from international leaders in the field will assist clinicians in deciding between operative and nonoperative treatment with patients after an ACL injury.

Keywords: ACL injury; ACL reconstruction; nonoperative treatment.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: O.R.A. has received honoraria from DJO. J.W.X. has received consulting fees from Arthrex and Trice Medical, nonconsulting fees from Arthrex, and royalties from Arthrex. F.H.F. has received educational support and hospitality payments from Smith & Nephew. V.M. has received consulting fees and speaking fees from Smith & Nephew.

Figures

Figure 1.
Figure 1.
ACL Consensus Meeting Panther Symposium 2019. ACL, anterior cruciate ligament.
Figure 2.
Figure 2.
As seen in T2-weighted magnetic resonance imaging sequences, the patient sustained a (A) complete anterior cruciate ligament rupture and (B) associated lateral meniscus root tear.
Figure 3.
Figure 3.
(A, B) Posterior tibial slope varies among patients, with greater slope increasing the risk of failure after anterior cruciate ligament (ACL) reconstruction. (C, D) Notch dimension varies among patients, with small notch width dimensions constituting a relative contraindication for double-bundle ACL reconstruction.
See this image and copyright information in PMC

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