English summary

Measure functional outcomes of surgical and non-surgical treatment of ACL injury – giving way, return to sports, hamstring muscle strength, strength of the quadriceps muscle, existence of knee hydrops and patient-related outcome measures (suggested use of KOOS and/or IKDC questionnaires) – before and after the start of the treatment of patients with ACL injury.

Explain that the return to sport activities is often at a lower level than before ACL injury, despite the fact that muscle strength of the affected leg is symmetrical again with respect to the unaffected leg.

Inform a patient with a cruciate ligament injury about the surgical and non-surgical treatment options.

Recommend cruciate ligament reconstruction to patients with symptomatic instability of the knee, non-improvement after physiotherapy and lack of response to changes in activities.

Inform younger patients (<20 years) and patients with a very active lifestyle (athletes) about the clearly increased risk of re-rupture following surgical treatment.

Include the fact that a reconstruction prevents injuries to the cartilage and meniscus – and accompanying surgeries – in the decision-making process.

Inform patients that anterior cruciate ligament reconstruction does not affect the development of secondary osteoarthrosis of the knee.

Offer patients older than 30 years with a lower activity level a non-surgical treatment as a serious alternative.

Advise and support patients with anterior cruciate ligament injury, both before and after surgery, to stop smoking and to bring their BMI within the normal range, if applicable.

Only perform a reconstruction on a knee with symmetrical mobility of the patella (left equal to right) and complete extension. Aim for a limited difference in quadriceps strength compared to the non-affected leg (less than 20%).

Consider referring the patient to a physiotherapist for pre-operative rehabilitation before an ACL reconstruction.

If indicated, perform an ACL reconstruction within five months of the injury if possible, to limit secondary damage to meniscus and cartilage.

Opt for an autograft in the case of primary ACL reconstruction, with both bone-patellar-tendon-bone and hamstring graft as options.

Perform an ACL reconstruction using a single-bundle or double-bundle technique.

Do not use synthetic grafts due to inferior results and detrimental complicating factors in the long term.

It is not possible to offer scientifically substantiated recommendations about the choice in type of fixation of the various grafts.

It is not possible to offer scientifically substantiated recommendations about the use of augmented or non-augmented primary suture repair in surgical treatment of the acute ACL rupture.

A skeletally immature child with ACL injury should preferably be treated conservatively until the child has reached skeletal maturity.

Consider an ACL reconstruction in skeletally immature children with persistent instability and – in addition to the usual complications – also discuss the potential growth problems and higher risk of re-rupture with the patient and his/her parents.

Do not use a brace in the post-operative course of treatment following an ACL reconstruction.

Combine strength training and neuromuscular training in the post-operative treatment.

Advise against high-burden physical rehabilitation, pivoting sports, knee-burdening work and risky activities in which the patient must be able to rely on the ACL reconstruction during the first three months after reconstruction.