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Unknown unknowns and lessons from non-operative rehabilitation and return to play of a complete anterior cruciate ligament injury in English Premier League football
  1. Richard Weiler1,2,3,4
  1. 1 University College London Hospitals NHS Foundation Trust & UCL Institute of Sport, Exercise and Health, London, UK
  2. 2 West Ham United Football Club Training Ground, Chadwell Heath, Essex, UK
  3. 3 The FA Centre for Disability Football Research, Burton Upon Trent, UK
  4. 4 Fortius Clinic, London, UK
  1. Correspondence to Dr Richard Weiler, University College London Hospitals NHS Foundation Trust & UCL Institute of Sport, Exercise and Health, London W1T 7HA, UK; rweiler{at}

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An illustrated example

An English Premier League (EPL) footballer decides to open-mindedly try, at least initially, non-operative and non-interventional treatment of a complete anterior cruciate ligament (ACL) rupture. At 5 weeks, he feels great and fully trusts his knee, sailing with confidence through every graded progression in his evolving rehabilitation programme. He continues with rehabilitation to full training within 8 weeks of a complete ACL injury.1 Now, almost 24 months later, he is still training and playing full competitive professional football. During 22 months available for team selection, there have been no episodes of instability, no knee pain, no effusions, no soft tissue injuries and no discernible impairment on function. There was no change on clinical ligament tests either. Treatment was entirely non-surgical with no use of needles for aspiration or injection. He remains aware that he is very lucky so far, that he cannot predict what could happen in future, possibly requiring surgery, and he is aware that risk of osteoarthritis is high following ACL injury whether reconstruction has taken place or not.2–4 Before jumping to conclusions, perhaps it is worth reading the full paper at BMJ Case Reports to decide for yourself what you may have done in this situation.1

Unknown unknowns

It is unusual for elite professional athletes to choose the uncertainty of non-operative treatment for an ACL injury when the quantity of research, and …

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  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.