What are the current guidelines for the conservative management of ACL injuries in adults?

Current guidelines for the conservative management of anterior cruciate ligament (ACL) injuries in adults focus on a structured rehabilitation programme emphasizing neuromuscular training, strength restoration, and functional stability without immediate surgery. Initial management includes education about activity modification to avoid instability episodes and swelling control through rest, ice, compression, and elevation. A tailored physiotherapy programme aims to restore range of motion, quadriceps and hamstring strength, and proprioception to improve knee function and reduce the risk of further injury. Conservative treatment is particularly considered for patients with low functional demands, partial ACL tears, or those who are not suitable candidates for surgery due to comorbidities or personal preference ¹.

Rehabilitation should be progressive and goal-oriented, focusing on regaining symmetrical knee function and safe return to activities. Functional bracing may be used adjunctively but is not routinely recommended as a substitute for rehabilitation. Regular assessment of knee stability and patient-reported outcomes guides the decision to continue conservative management or consider delayed surgical reconstruction if instability persists or functional goals are unmet ¹.

Recent literature supports these principles and highlights the importance of individualized rehabilitation protocols that incorporate neuromuscular training to reduce the risk of secondary injuries and improve long-term outcomes (Attri et al., 2025). Although much of the recent research focuses on surgical techniques, there is growing recognition that conservative management with comprehensive rehabilitation can be effective in selected adult patients, especially when combined with patient education and close monitoring (Attri et al., 2025).