Nonsurgical Treatment of Anterior Cruciate Ligament Tears: What Is the Evidence and Who Are the Candidates?

Anterior cruciate ligament injuries commonly affect athletes and nonathletes. In the United States, about 200,000 injuries and 100,000 reconstructions are reported annually. While anterior cruciate ligament reconstruction is the standard treatment, nonsurgical options can yield similar short- and long-term results for selected patients with a structured rehabilitation program. Also, anterior cruciate ligament reconstruction has risks, including reinjury, contralateral injuries, and postoperative osteoarthritis. Early rehabilitation, or prehabilitation, accelerates recovery of symptoms, strength, and knee function. It serves two main purposes: identifying whether a patient is a coper and suitable for continued nonsurgical management or preparing them for surgery if needed. Nonsurgical treatment may be appropriate for selected patients. This review provides a practical guide to nonsurgical management, emphasizing the importance of patient selection, early individualized rehabilitation, and patient education to optimize outcomes.