ACL Tear… Do I really need surgery?
Besides the different stories that many people might tell you, there is a way to determine the necessity of having an ACL reconstruction surgery. Most patients do feel much better after a certain time even without having surgery. This means that they will even recover full range of mobility and even adequate strength for daily life activities.
It can be hard to accept the fact surgery and rehabilitation might be needed after ACL surgery if the knee starts to feel good again but the true is that it depends on many other factors like the sports that you will practice in the future and the overall stability of the knee. An unstable knee might put your knee in a more prone situation to develop degenerative conditions on the menisci and the cartilage surfaces, not giving you many options once the damage on those structures is done.
Unfortunately, if the ACL is completely torn, there is no chance of the ligament healing properly. While not everyone needs a functional ACL to perform activities, athletes who participate in certain sports that require pivoting maneuvers are unlikely to be able to return without a properly working ACL.
So who really needs ACL surgery?
1. Most people expecting to return to high-level or high-demand athletic activities in sports
2. Individuals who experience recurrent episodes of knee instability due to anterior cruciate ligament deficiency
3. Patients who do not want to attempt conservative therapy
| High-Demand Sports: Football, Soccer, Basketball, Skiing, Gymnastics, Hockey (Ice and Field), Wrestling, Lacrosse, Rugby, Singles Tennis,Cheerleading… |
| Moderate-Demand Sports: Baseball, Doubles Tennis, Track (Field Events)… |
| Low-Demand Sports: Running/Jogging, Cycling, Crew… |
Current Recommendations
ACL reconstruction surgery should be considered for all individuals who desire a return to sports or activities that require lateral pivoting of the knee, or those who experience recurrent instability of the knee.
| Pros | Cons |
| 1. Allows return to high-level athletic activity | 1. Surgery is not 100% effective — some people don’t improve |
| 2. May protect future damage to the knee cartilage | 2. Many activities can be accomplished without an ACL |
| 3. Offers a near-normal knee | 3. There are complications that may occur |
Conservative approach for patients that choose not to have surgery should take into consideration certain guidelines. In nonsurgical treatment, progressive physical therapy and rehabilitation can restore the knee to a condition close to its pre-injury state and educate the patient on how to prevent instability. This may be supplemented with the use of a hinged knee brace. However, many people who choose not to have surgery may experience secondary injury to the knee due to repetitive instability episodes.
Surgical treatment is usually advised in dealing with combined injuries (ACL tears in combination with other injuries in the knee). However, deciding against surgery is reasonable for select patients. Nonsurgical management of isolated ACL tears is likely to be successful or may be indicated in patients:
- With partial tears and no instability symptoms
- With complete tears and no symptoms of knee instability during low-demand sports who are willing to give up high-demand sports
- Who do light manual work or live sedentary lifestyles
- Whose growth plates are still open (children)
