gms | German Medical Science

Introduction: ACL rupture may result in increased tibiofemoral laxity and impaired neuromuscular function, which ultimately may lead to knee instability and dysfunction. Individuals who opt to choose surgery, due to these changes, may be defined as "non-copers". Conversely, "copers" may be defined as individuals with an ACL deficient knee who do not have functional impairment and instability and who successfully resume pre-injury activity levels without surgical intervention. This narrative literature review is designed to explore the differences and outcomes between individuals who have had anterior cruciate ligament (ACL) reconstruction and those who did not undergo surgical intervention following a tear of the ACL. Second, to review the evidence related to the ability to identify individuals who may or may not need surgery after an ACL rupture. Finally, to describe the differences between copers and non-copers.

Materials & Methods: An electronic search was conducted up to April 2011, using medical subject headings and free-text words. Subject-specific search was based on the terms "anterior cruciate ligament reconstruction versus conservative treatment", "copers", "non-copers".

Results: A similar percentage of copers and non-copers return to sporting activity. Three papers used an algorithm and screening examination involving individuals with ACL injuries. Evidence exists that, as opposed to copers, non-copers have: deficits in quadriceps strength, vastus lateralis atrophy, quadriceps activation deficits, altered knee movement patterns, reduced knee flexion moment, and greater quadriceps/hamstring co-contraction.

Conclusions: ACL screening examination shows preliminary evidence for detecting potential copers. Objective differences exist between copers and non-copers. Individuals with ACL injury should be informed of the possibility of good knee function following a non-operative rehabilitation program.