Treatment strategies for anterior cruciate ligament (ACL) injuries continue to evolve. Evidence supporting best practice guidelines for the management of ACL injury is to a large extent based on studies with low-level evidence. An international consensus group of experts was convened to collaboratively advance toward consensus opinions regarding the best available evidence on operative vs. non-operative treatment for ACL injury. The purpose of this study is to report the consensus statements on operative vs. non-operative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. Sixty-six international experts on the management of ACL injuries, representing 18 countries, were convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the Scientific Organizing Committee and Session Chairs for the three working groups. Panel participants reviewed preliminary statements prior to the meeting and provided the initial agreement and comments on the statement via an online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Eighty percent agreement was defined a-priori as consensus. A total of 11 of 13 statements on operative v. non-operative treatment of ACL injury reached the consensus during the Symposium. Nine statements achieved unanimous support, two reached strong consensus, one did not achieve consensus, and one was removed due to redundancy in the information provided. In highly active patients engaged in jumping, cutting, and pivoting sports, early anatomic ACL reconstruction is recommended due to the high risk of secondary meniscus and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight plane activities, non-operative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability, or when episodes of giving way occur, anatomic ACL reconstruction is indicated. The consensus statements derived from international leaders in the field will assist clinicians in deciding between operative and non-operative treatments with patients after an ACL injury.Level of evidence V.

中文翻译：

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前交叉韧带损伤后的治疗：豹专题讨论会ACL治疗共识组。

前交叉韧带（ACL）损伤的治疗策略不断发展。支持ACL损伤最佳实践指南的证据在很大程度上是基于低水平证据的研究。召集了一个国际共识专家组，以就关于ACL损伤的手术和非手术治疗的最佳可用证据的共识意见达成共识。这项研究的目的是报告在2019年ACL共识会议豹专题讨论会上制定的关于ACL损伤的手术和非手术治疗的共识性声明。代表18个国家的66位ACL损伤管理国际专家召集并参与了基于Delphi方法达成共识的过程。提议的共识声明由科学组委会和三个工作组的会议主席起草。小组成员在会议之前审查了初步声明，并通过在线调查提供了初步协议和评论。会议期间，对每项声明进行了讨论和辩论，然后进行了最后表决。百分之八十的协议被定义为先验共识。在座谈会上，关于ACL损伤的手术与非手术治疗的13项陈述中，共有11项达成了共识。九份声明获得了一致支持，两份达成了强烈共识，一份未达成共识，另一份由于提供的信息多余而被删除。在从事跳跃，切割和枢纽运动的高强度患者中，由于继发性半月板和软骨损伤且手术延迟的高风险，建议尽早进行解剖学ACL重建，尽管建议进行一段逐步康复以解决损伤和改善神经肌肉功能。对于寻求恢复直线活动的患者，可以接受有组织的渐进性康复的非手术治疗。但是，由于持续的功能不稳定或当发生让步时，需要进行解剖性ACL重建。来自该领域国际领导者的共识声明将帮助临床医生确定ACL损伤后患者的手术治疗与非手术治疗之间的关系。