A 22-year-old football player gives a 'pop' sensation and immediate knee swelling after a non-contact deceleration injury. Lachman test is positive (Grade 2B — firm endpoint absent). MRI confirms an isolated ACL tear. He wants to return to high-level football. The most appropriate management is:

• A Conservative management with physiotherapy and dynamic stabilising exercises alone
• B ACL reconstruction with patellar tendon (BPTB) or hamstring tendon graft ✓
• C Primary ACL repair with suture augmentation
• D Knee bracing and activity modification only

Explanation

In young, active athletes who wish to return to pivoting sports after ACL rupture, surgical reconstruction is the standard of care due to high rates of knee instability, meniscal damage, and secondary OA with conservative management alone. Both bone-patellar tendon-bone (BPTB) and hamstring tendon (quadrupled semitendinosus ± gracilis) grafts provide equivalent functional outcomes in RCTs; BPTB may have slightly higher early strength and rerupture resistance, while hamstring grafts have lower donor-site morbidity. Primary repair alone has high failure rates in mid-substance ACL tears. Bracing does not restore mechanical stability for pivoting sport.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.