From the Guidelines
ACL laxity treatment should prioritize autograft over allograft for young and/or active patients to improve patient outcomes and decrease ACL graft failure rate, as recommended by the American Academy of Orthopaedic Surgeons clinical practice guideline summary 1.
Treatment Options
When treating ACL laxity, the following options should be considered:
- Conservative management for mild to moderate cases, including physical therapy focusing on quadriceps and hamstring strengthening, proprioceptive exercises, and functional training for 6-12 weeks.
- Surgical reconstruction using autografts (patellar tendon or hamstring tendons) for athletes or individuals with significant instability affecting daily activities.
Post-Surgery Rehabilitation
Post-surgery rehabilitation typically lasts 6-9 months, progressing from range of motion exercises to strength training and sport-specific activities, as supported by the systematic review of clinical practice guidelines 1.
Considerations
Treatment choice should consider the patient's age, activity demands, and associated injuries, as ACL laxity can lead to meniscal tears and early osteoarthritis if left untreated in active individuals, highlighting the importance of individualized treatment plans 1.
Key Recommendations
- Autograft should be considered over allograft for young and/or active patients to improve patient outcomes and decrease ACL graft failure rate 1.
- Immediate knee mobilisation and strength/neuromuscular training should be used during ACL postoperative rehabilitation 1.
- Treatment goals should be discussed with the patient, and the surgeon could proceed with any of the three treatments considered Appropriate, including rehabilitation with a gradual return to recreational sports activity, subsequent reconstruction if necessary, or surgery based on the patient’s preference 1.
From the Research
Treatment Options for ACL Laxity
- Non-operative treatment can be successful in a select group of patients with acute ACL injury and mild instability, as shown in a study published in 2010 2.
- The study found that 87% of patients had improved Lachman test results and 76% showed no laxity in the pivot shift test after non-operative treatment.
- Operative treatment, such as ACL reconstruction, is also an option and can yield better functional outcomes than conservative management, according to a review of publications in 2018 3.
- However, the review also found that conservative treatment can be effective in some cases, and the decision between operative and conservative treatment should be made on a case-by-case basis.
Factors to Consider in Treatment Decision
- The degree of instability and laxity in the knee joint should be taken into account when deciding on treatment, as shown in a study published in 2010 2.
- Patient-related factors, such as age and activity level, should also be considered when discussing management options with patients, according to a review of evidence-based recommendations in 2019 4.
- The type of graft used in ACL reconstruction, such as autograft or allograft, can also affect the outcome of treatment, as shown in a meta-analysis published in 2010 5.
Rehabilitation and Return to Sport
- Rehabilitation is an important part of treatment for ACL laxity, and should be tailored to the individual patient's needs and goals, according to a review of evidence-based recommendations in 2019 4.
- Criteria for return to sport should be based on functional outcomes and stability measures, such as the Lachman test and pivot shift test, as shown in a study published in 2010 2.
- A multidisciplinary approach may be necessary to address complex cases, such as revised and infected ACL reconstruction, as shown in a case report published in 2024 6.