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I bunged up my knee but I want to finish the football season before having surgery. I know there's a chance it could get worse if I reinjure it. Can I delay the surgery and still play?

Highly active people who injure their anterior cruciate ligament (ACL) in the knee are often faced this important treatment decision: surgery or no surgery? Until now, athletes have been encouraged to put aside their immediate sports play for the opportunity to get back in the game later. Early surgery has been routinely advised for athletes who want to resume high-demand activities. Until recently, we didn't have a way to tell who is a good candidate for nonoperative care and who should just go ahead and have the surgery. But researchers at the University of Delaware have put together clinical guidelines using a screening exam that might just do the trick. It's based on more than 10 years' worth of study, clinical trials, and careful evaluation. The athletes included were those who put in more than 50 hours each year of high-demand activities such as jumping, cutting, pivoting, or lateral movements. Their results (72 per cent success rate) was much higher than in other studies where patients decided for themselves not to have surgery. Their work will have to be repeated by others to validate their findings. But for now, they report an increased ability to return highly active adults to their preinjury level of activity safely and effectively without surgery. Your surgeon is the best one to advise you on this decision. The type of injury, severity, and the presence of other injuries can make a difference. For example, a ruptured ACL along with damage to other knee ligaments or injury to the other knee, the meniscus, or joint cartilage makes the person a poor candidate for nonoperative care. Likewise, fractures, dislocations, back injuries, or nerve injuries also put the patient at increased risk for a poor result with conservative care. If you have swelling or the knee buckles or gives way underneath you, then surgery is probably necessary before going back to sports. There are other clinical tests including a series of hopping activities that can be done to determine the stability of your knee. If you pass those tests, then you might be a good candidate for a short rehab program before getting back into the game. Rehab should include a focus on perturbation exercises (putting the patient off balance), muscle strengthening, and cardiovascular exercise (aerobic training). Agility and coordination training along with sport-specific skills are also important. Before returning to sports participation, each athlete should pass a battery of functional tests. This is necessary to be cleared for full return to preinjury activities.

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