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7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Austrian Society of Physical Medicine and Rehabilitation

26.-29.10.2011, Salzburg, Austria

Identifying individuals with an anterior cruciate ligament deficient knee as copers and non-copers: a narrative literature review

Meeting Abstract

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  • corresponding author presenting/speaker Yonatan Kaplan - Jerusalem Sports Medicine Institute, Lerner Sports Center, Hebrew University of Jerusalem, Jerusalem, Israel

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation. Salzburg, 26.-29.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11esm045

doi: 10.3205/11esm045, urn:nbn:de:0183-11esm0450

Published: October 24, 2011

© 2011 Kaplan.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



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.