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Treatment after ACL injury: Panther Symposium ACL Treatment Consensus Group
  1. Theresa Anita Diermeier1,
  2. Ben B Rothrauff2,
  3. Lars Engebretsen3,
  4. Andrew Lynch4,
  5. Eleonor Svantesson5,
  6. Eric Andrew Hamrin Senorski6,
  7. Sean J Meredith7,8,
  8. Thomas Rauer9,
  9. Olufemi R Ayeni10,
  10. Mark Paterno11,
  11. John W Xerogeanes12,
  12. Freddie H Fu7,
  13. Jon Karlsson13,
  14. Volker Musahl7
  15. the Panther Symposium ACL Treatment Consensus Group
    1. 1 Department of Sportorthopedics, Klinikum rechts der Isar der Technischen Universitat Munchen, Munchen, Germany
    2. 2 Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
    3. 3 Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
    4. 4 Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    5. 5 Institue of Clinical Sciences, Department of Orthopaedics, Goteborgs Universitet, Goteborg, Sweden
    6. 6 Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Gothenburg, Sweden
    7. 7 Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    8. 8 Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
    9. 9 Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland
    10. 10 Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
    11. 11 Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
    12. 12 Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, USA
    13. 13 Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
    1. Correspondence to Dr Theresa Anita Diermeier, Department of Sportorthopedics, Klinikum rechts der Isar der Technischen Universitat Munchen, Munchen 81675, Germany; resi.diermeier{at}


    Treatment strategies for ACL injuries continue to evolve. Evidence supporting best practice guidelines to manage ACL injury is largely based on studies with low-level evidence. An international consensus group of experts was convened determine consensus regarding best available evidence on operative versus non-operative treatment for ACL injury. The purpose of this study is to report the consensus statements on operative versus non-operative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. Sixty-six international experts on the management of ACL injuries, representing 18 countries, convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the Scientific Organising Committee and Session Chairs. Panel participants reviewed preliminary statements prior to the meeting and provided initial agreement and comments on the statement via online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Eighty per cent agreement was defined a priori as consensus. A total of 11 of 13 statements on operative versus non-operative treatment of ACL injury reached consensus during the Symposium. Nine statements achieved unanimous support, two reached strong consensus, one did not achieve consensus, and one was removed due to redundancy in the information provided. In highly active patients engaged in jumping, cutting and pivoting sports, early anatomical ACL reconstruction is recommended due to the high risk of secondary meniscus and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight plane activities, non-operative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability, or when episodes of giving way occur, anatomical ACL reconstruction is indicated. The consensus statements derived from international leaders in the field may assist clinicians in deciding between operative and non-operative treatment with patients after an ACL injury. Level of evidence: Level V

    • anterior cruciate ligament
    • consensus statement
    • knee ACL

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    • Twitter @larsengebretsen, @senorski

    • Presented at This article has been co-published in the British Journal of Sports Medicine, Knee Surgery, Sports Traumatology, Arthoscopy, Journal of ISAKOS and the Orthopaedic Journal of Sports Medicine.

    • Collaborators Panther Consensus Group Olufemi R. Ayeni, Charles H. Brown Jr., Terese L. Chmielewski, Mark Clatworthy, Stefano Della Villa, Theresa Diermeier, Lars Engebretsen, Lucio Ernlund, Christian Fink, Freddie H. Fu, Alan Getgood, Timothy E. Hewett, Yasuyuki Ishibashi, Darren L. Johnson, Jon Karlsson, Andrew D. Lynch, Jeffrey A. Macalena, Robert G. Marx, Jacques Menetrey, Sean J. Meredith, Volker Musahl, Kentaro Onishi, Mark V. Paterno, Thomas Rauer, Benjamin B. Rothrauff, Laura C. Schmitt, Romain Seil, Eric H. Senorski, Rainer Siebold, Lynn Snyder-Mackler, Tim Spalding, Eleonore Svantesson, Kevin E. Wilk, John W. Xerogeanes.

    • Contributors TD, BBR, JK, VM, ES, EAHS, TR and SJM contributed substantially to the conception of the paper and interpretation of data. LE, AL, ORA, MP, JWX and FF contributed substantially towards revising the manuscript critically and final approval of this manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

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

    • Data availability statement All data relevant to the study are included in the article