ArticleThe American journal of sports medicine2026
Patient-Reported Knee Function and Return-to-Sport Rates After Nonsurgical and Surgical Treatment of an Acute Anterior Cruciate Ligament Injury: Results From the NACOX Prospective Cohort Study.
Article in The American journal of sports medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe best treatment for acute anterior cruciate ligament (ACL) injuries (surgical or nonsurgical) remains uncertain, particularly regarding return to sport (RTS) and knee function. PURPOSE: To compare patient-reported knee function (International Knee Documentation Committee Subjective Knee Form [IKDC-SKF]) and RTS between non-ACL reconstruction (ACLR) and ACLR treatment strategies 24 months after ACL injury or reconstruction and identify predictors of these outcomes. STUDY
designCohort study; Level of evidence, 2.
methodsFrom the NACOX multicenter cohort, 272 patients (mean age, 25.5 years; 95% CI, 24.6-26.3 years; 52% females) with acute ACL injuries were followed for 24 months after ACL injury or ACLR. Treatment (non-ACLR vs ACLR) was determined via shared decision-making in routine practice. IKDC-SKF scores were collected at 3, 6, 12, and 24 months and analyzed using a linear mixed-effects model adjusted for age, sex, preinjury activity level, and new serious knee injury. RTS was defined as return to preinjury Tegner level or higher. Risk factors for not returning to sport were evaluated using log-binomial regression.
resultsThe ACLR group had higher preinjury Tegner levels (8 vs 6.5;
conclusionIn this cohort of patients with ACL injury, both nonsurgical management and ACLR, determined through shared decision-making, resulted in comparable patient-reported knee function and RTS rates at 24 months, although the ACLR group was younger and had higher activity level. Non-ACLR treatment may therefore be a viable option for selected patients, particularly those who are older or have lower activity demands, to achieve satisfactory RTS outcomes. Older age (26-40 years) was associated with a higher risk of not returning to sport after ACLR, highlighting the importance of individualized treatment decisions.
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