Handlungsalgorithmus bei akuter Verletzung des vorderen Kreuzbandes

The aim of treatment for an acute anterior cruciate ligament (ACL) injury is to return the patient to an acceptable level of activity without “giving way” phenomena. Prognostically relevant accompanying pathologies should also be considered when making treatment decisions. Treatment options for acute ACL injuries include early reconstruction or primary physiotherapy with optional ACL reconstruction. The accompanying pathologies play an important role in determining the right indication, as, for example, repairable meniscus injuries or distal tears of the medial collateral ligament require surgery. Furthermore, patient-specific factors play a crucial role (e.g., age and level of activity) in determining the right indication. An isolated ACL injury can be treated primarily nonoperatively. Rehabilitative measures should be used to improve pain, swelling, and post-traumatic restriction of movement before neuromuscular training is conducted. In the process, a “screening” test consisting of jump tests, patient-reported outcome measures, and the occurrence of giving way phenomena can be used to distinguish between copers and noncopers. For noncopers, surgical treatment should be recommended. ACL reconstruction should also be considered if instability events (giving way) or secondary meniscus injuries occur.