New York State Medical Treatment Guidelines for Anterior Cruciate Ligament (ACL) Injury in workers compensation patients

The guidelines for the treatment of Anterior Cruciate Ligament (ACL) Injury have been developed by the New York State Workers Compensation Board. Their purpose is to assist physicians, and healthcare professionals in figuring out the appropriate treatment for this condition.

Professionals in healthcare managing Anterior Cruciate Ligament (ACL) Injury can use these guidelines from the Workers Compensation Board to make well-informed decisions about the best level of care for their patients.

It is crucial to emphasize that these guidelines are not meant to substitute clinical judgment or professional expertise. The ultimate decision regarding care should be a collaborative one, with the involvement of both the patient and their healthcare provider.

Description / Definition

Rupture or partial rupture of the anterior cruciate ligament; may be associated with other internal derangement of the knee.


Mechanism of Injury

May be caused by virtually any traumatic force to the knee but most often caused by a twisting or a hyperextension force.


Specific Physical Findings

Findings on physical exam include effusion or hemarthrosis, instability, Lachman’s test, pivot shift test, and anterior drawer test.


Diagnostic Testing Procedures

MRI, Radiographs
Recommended – in select patients.
Indications: May show avulsed portion of tibial spine but this is a rare finding.


Non-Operative Treatment

Recommended – in select patients as clinically indicated.
Rest/restricted activity, off-loading with crutches or cane, ice, elevation, bracing, casting, orthotics, rehabilitation and active and/or passive therapy, NSAIDs, APAP and therapeutic injections.


Surgical Indications / Operative Treatment

If a non-operative treatment approach is initially recommended, surgery may be indicated after the failure of conservative management. The patient must continue to exhibit the designated objective findings, subjective symptoms and (where applicable) imaging findings.
Recommended – in select patients as clinically indicated.

Post-Operative Therapy

Therapy, bracing.
Recommended – in select patients as clinically indicated.





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