Anterolateral instability is a common lesion of the knee which can result in significant disability. Without treatment, this problem can typically cause recurrent meniscal tearing, increased joint laxity, progressive giving way, joint surface deterioration and restrictions of functional activities. Although surgery can be performed to improve static stability, many patients elect a nonoperative approach based on a knee rehabilitation program. The purpose of this paper is to discuss anterolateral knee instability and the authors' conservative management program. Two collegiate athletes are presented as case studies. Both had positive signs of anterolateral instability, but following arthroscopic surgery and rehabilitation, they were asymptomatic with no limitations in functional activity. One of the subjects discontinued rehabilitation prematurely and resumed sports with no recurrence of functional instability or synovitis, but continued with patellofemoral dysfunction. Nonoperative treatment can be effective in providing functional stability to the ACL-deficient knee with signs of anterolateral instability (i.e., positive pivot shift). More reports of similar cases and rehabilitation studies with long-term follow-up are necessary for comparison with surgical results, which are currently controversial and often disappointing.
J Orthop Sports Phys Ther 1989;11(6):237-244.