Management after acute injury of the anterior cruciate ligament (ACL), part 2: management of the ACL‐injured patient
Wolf Petersen, Martin Häner, Daniel Guenther, Patricia M. Lutz, Andreas B. Imhoff, Mirco Herbort, Thomas Stein, Christian Schoepp, Ralph Akoto, Jürgen Höher, Sven Scheffler, Amelie Stöhr, Thomas Stoffels, Julian Mehl, Tobias Jung, Christian Eberle, Cara Vernacchia, Andree Ellermann, Matthias Krause, Natalie Mengis, Peter E. Müller, Raymond Best, Andrea Achtnich
Abstract
PURPOSE: The aim of this consensus project was to create a treatment algorithm for the management of the ACL-injured patient which can serve as an aid in a shared decision-making process. METHODS: For this consensus process, a steering and a rating group were formed. In an initial face-to-face meeting, the steering group, together with the expert group, formed various key topic complexes for which various questions were formulated. For each key topic, a structured literature search was performed by the steering group. The results of the literature review were sent to the rating group with the option to give anonymous comments until a final consensus voting was performed. Sufficient consensus was defined as 80% agreement. RESULTS: During this consensus process, 15 key questions were identified. The literature search for each key question resulted in 24 final statements. Of these 24 final statements, all achieved consensus. CONCLUSIONS: This consensus process has shown that ACL rupture is a complex injury, and the outcome depends to a large extent on the frequently concomitant injuries (meniscus and/or cartilage damage). These additional injuries as well as various patient-specific factors should play a role in the treatment decision. The present treatment algorithm represents a decision aid within the framework of a shared decision-making process for the ACL-injured patient. LEVEL OF EVIDENCE: Level V.