Conservative Management of Acute Anterior Cruciate Ligament Rupture in Recreational Athletes: A Pilot Case Series

TL;DR

This study explores non-surgical treatment for ACL ruptures in recreational athletes using biologics and rehabilitation, showing successful recovery and return to sports.

Contribution

Demonstrates that conservative treatment with biologics can achieve ligament healing and stability in acute ACL ruptures.

Findings

MRI showed restored ACL continuity in all patients after treatment.

All patients returned to recreational sports within six months without complications.

Abstract

Background and aim: Surgical anterior cruciate ligament reconstruction (ACLR) remains the standard treatment for acute anterior cruciate ligament (ACL) rupture in highly active individuals but entails surgical risks, prolonged recovery, and incomplete return to sport in some cases. Conservative approaches enhanced with biologics, such as platelet-rich plasma (PRP) or autologous conditioned serum (ACS), have gained interest as potential alternatives in selected patients. This study aimed to describe ligament healing, clinical stability, and short-term return to sport in recreational athletes with acute ACL rupture treated conservatively with intra-articular PRP or ACS plus structured rehabilitation.

Methods: This retrospective pilot case series included eight recreational athletes (four females, median age 32 years) with magnetic resonance imaging (MRI) and clinically confirmed acute ACL rupture (<4 weeks from trauma) who opted for non-operative care. All received four ultrasound-guided intra-articular injections of PRP (GPS III; Warsaw, IN: Zimmer Biomet) or ACS (Orthokine) over six weeks, followed by a standardized rehabilitation protocol. MRI evaluation at 21-24 weeks assessed ACL continuity (grade 0-3). Clinical assessment included the pivot-shift test graded according to the International Knee Documentation Committee (IKDC) grading system, instrumented Lachman testing, the Tegner Activity Scale (TAS), and the International Knee Documentation Committee (IKDC) score at 24 weeks.

Results: MRI showed restored ACL continuity in all patients (grade 0 in 7/8; grade 1 in 1/8). Post-treatment pivot-shift testing showed grade 0 in 7/8 patients and grade 1 in 1/8 patients, while the Lachman test was negative in all patients. All patients returned to recreational sports within six months post-injury. No re-ruptures or complications were observed during a minimum six-month follow-up after return to sport.

Conclusions: This study shows that intra-articular biologics (PRP or ACS) combined with structured rehabilitation were associated with MRI continuity, clinical stability, and safe return to sport at six months in recreational athletes with acute ACL rupture. This conservative treatment could be considered an alternative, and further investigation is warranted.

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