LAUSR

The athletic seasons are re-opening for all levels of athletes, top level athletes and recreational athletes alike. Increasing speed and power and more people participating in different kinds of sports inevitably leads to a rising number of diagnosed anterior cruciate ligament (ACL) injuries [34]. By and large, restoring knee function and returning to athletic activity requires intact rotatory knee stability. Therefore, early anatomic ACL reconstruction is often recommended. Following an ACL injury, three different patient responses are observed: (1) a “coper” can return to the pre-injury levels without surgery and subjective instability; (2) an “adapter” reduces his/her level of activity to avoid subjective instability; and a (3) “non-coper” cannot return to pre-injury activity levels due to subjective instability and episodes of giving way [23]. A screening tool to differentiate potential “copers” from “non-copers” was developed and includes a combination of hop tests, an assessment of quadriceps strength, questionnaires on general knee function, and an account of the frequency of giving-way episodes [5, 22]. However, the reported rate of true “copers” in the literature is low. As an example, one prospective trial of 345 highly active patients with sub-acute ACL tears were screened for the possibility of non-operative treatment. Based on the results of the screening tests (i.e., overall function, various hop tests and the degree of subjective instability), 146 patients were classified as potential “copers”. At final 10-year follow-up, 93% of these previously designated “copers” had underwent ACL reconstruction [12]. Therefore, in young, active patients, wishing to return to jumping, cutting, and/or pivoting sports, ACL reconstruction remains the preferred treatment [20]. This is especially true given the poorer return to sport rates (i.e., 10–30%) of individuals treated non-operatively [5, 26]. * Jon Karlsson [email protected]