Growing evidence suggests that structured rehabilitation after an ACL rupture, with later surgery if necessary, leads to similar results to immediate reconstruction, Australian experts say.

While UK and Dutch guidelines promote conservative treatment, and US guidelines recommend early reconstruction, Australia’s guidelines do not directly tackle the question of rehab versus early surgery.

That is a problem, according to a team of authors from Melbourne’s La Trobe University and University Hospital Geelong, who published a piece in JAMA Insights this month advocating conservative management.

They pointed to a 2022 meta-analysis that found early surgery was not associated with better outcomes in self-reported knee function, health-related quality of life or the likelihood of osteoarthritis after 5-10 years.