Author(s): ARRIAZA, R., ARRIAZA, A., BUJÁN, E., HIDALGO, P., Institution: UNIVERSITY OF A CORUÑA, Country: SPAIN, Abstract-ID: 432

INTRODUCTION:
Traditional orthopedic dogma has historically mandated surgical reconstruction of the knee anterior cruciate (ACL) and lateral colateral ligaments (LCL, relegating non-operative care to low-demand patients or "salvage" scenarios. Maybe the historical reliance on surgery was largely driven by a biologically unfavorable mechanical environment and pro-inflammatory ligamentous distraction during immobilization rather than intrinsic healing deficiency.

METHODS:
This presentation synthesizes a comparison between the pre-2020 analysis of the results of conservative treatment of ACL and LCL injuries, contrasted against modern datasets. It is illustrated with the cases of several first división football players from Real Madrid, Watford, Deportivo de La Coruña and FC Dynamo, and even a capoeira athlete
RESULTS:
• Pre-2020 Synthesis: Some series (3) reported "surprisingly good results" regarding stability and absence of pain in uncomplicated knee dislocations trated conservatively, while most (4) associated non-operative management of dislocations with 100% unsatisfactory results. Historically, "conservative" care typically utilized plaster casts in "slight flexion," a position now understood to be insufficient for primary apposition.
• Post-2020 Synthesis: While spontaneous ACL healing was found annecdotically in patients managed with standard rehabilitation, the CBP (1) -immobilizing the knee at 90° flexion for four weeks- reported a 90% healing rate on MRI at 3 months. This position facilitates primary apposition of the ruptured remnants, transforming a once-hostile environment into a stable cradle for tissue bridge formation.
• LCL Specifics: Modern conservative management for Grade 1–2 lesions, yielded a 100% Return to Play (RTP) rate in elite footballers (2). The treatment protocol utilizes a hinged brace to block the terminal 30° of extension for the first two weeks, allowing healing. The average RTP time in the first división football players was 7 weeks, without recurrence.

CONCLUSION:
The management of ACL and LCL ruptures has transitioned from a surgery-by-default paradigm to a performance-optimized conservative strategy. Evidence-based protocols demonstrate that non-surgical treatment is a viable pathway for athletes, even high-level ones, provided it includes rigorous clinical guidance and serial MRI monitoring. These results suggest that by optimizing the mechanical environment to facilitate the apposition of ruptured remnants, we can achieve high-level functional outcomes.

BIBLIOGRAPHY:
1.- Filbay SR, Dowsett M, Chaker Jomaa M, et al. Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol. Br J Sports Med. 2023 Dec;57(23):1490-1497
2.- Haslhofer DJ, Jaggard MKJ, Abdul W, et al. Isolated Clinically Diagnosed Grades 1-2 Lateral Collateral Ligament Injuries in Elite Athletes Do Not Require Surgery. Orthop J Sports Med. 2025 Dec 1;13(12):23259671251391357
3.- Taylor AR, Arden GP, Rainey HA. Traumatic dislocation of the knee. A report of forty-three cases with special reference to conservative treatment. J Bone Joint Surg Br. 1972 Feb;54(1):96-102
4.- Ríos A, Villa A, Fahandezh H, et al. Results after treatment of traumatic knee dislocations: a report of 26 cases. J Trauma. 2003 Sep;55(3):489-94