There is an evolving body of literature that shows non-elite patients who have sustained an ACL injury have similar knee outcomes up to 5yrs post-op than those who elect to have surgical reconstruction (Frobell et al, 2013) - see more details of this in evidence based blog by Adam Culvenor and Christian Barton here.
The question therefore needs to be asked; if the results for surgical management and conservative management in non-elites are similar, why do almost all elite
#1: 72% of ACL reconstruction patients returned to pre-injuy level sport at 2yrs follow up when their pre-op physio program included 10 sessions of neuromuscular training vs 63% whose pre-op physio did not (Failla et al, 2016).
#2: As little as 5 weeks intensive pre-op physio that set goals of attaining 90% limb symmetry in quads & hamstring strength and single leg hop distance prior to ACL reconstruction resulted in superior knee function outcomes at 2yrs post-op vs "usual
As a clinician I often see a gradual decline in follow-ups with ACL reconstruction patients between 3-6 months post-op - despite best efforts to maintain patient motivation. The reasons for patient attrition are no doubt multi-factorial; escalating medical costs, family, work & life commitments and waning motivation; are reasons just to name a few. The good news for both clinicians and patients, is that new research has shown that if the patient can maintain motivation to att