Do I Need Surgery for My Torn ACL?
Over the years, we have seen an increase in anterior cruciate ligament (ACL) injuries that have come to my clinic. This could be due to the multitude of factors. However, a common question that has always come up is, “ Do I Need Surgery?”. In this week’s blog, we discuss more about this.
What Is Done in an ACL Surgery?
Nowadays, surgical intervention is commonly used as a treatment for the ACL, through an ACL reconstruction. This is usually reconstructed by taking a graft from a tendon from another area, usually the hamstring, kneecap or quadricep. This is then followed by progressive rehabilitation of 9-16 months before it can be considered fully recovered.
The rationale for an ACL reconstruction was due to the understanding that the ACL is important for knee function. In the long run, an ACL deficient knee could lead to more injuries of the other knee ligament, the meniscus, and degeneration of the knee joint in general.
Do I Really Need the ACL Reconstruction?
Going back to our original question, we can take a look at the studies available that compare patients with a surgical and non-surgical intervention of their ACL. A well conducted study by Frobell et al (2013) studied the short term and long terms effects of the an ACL reconstruction by following up with athletes who were randomly allocated either an immediate ACL reconstruction, delayed reconstruction and no surgery. This study found that there was no significant differences between the 3 groups in variables such as pain, function in sports and active daily living and overall physical health.
Furthermore, there is a well-documented case of an English Premier League football player, from West Ham United, who managed to return to full training in less than 8 weeks of non-surgical treatment of a full ACL tear. In the following 18 months, the player also managed to remain fully fit. This shows that a reconstruction is not the only treatment choice to be considered when it comes to your ACL.
Which Treatment Should I Undertake?
With the study by Frobell et al (2013), it is important to note that patients with multiple ligament injuries were excluded. Thus, it may not be suitable for all patients. It is important to seek medical opinion from your doctor and physiotherapist and then make a shared decision from there. There are multiple factors involved in an ACL injury and these should be considered as well in the decision making process.
If you have any more questions or would like our physiotherapists to assess or treat your ACL injury, feel free to drop us a question, talk to us, or fill in the form below. Do check out our instagram page too.
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Dhillon K. S. (2014). “‘Doc’ do I need an anterior cruciate ligament reconstruction? What happens if I do not reconstruct the cruciate ligament?”. Malaysian orthopaedic journal, 8(3), 42–47. https://doi.org/10.5704/MOJ.1411.010
Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013 Jan 24;346:f232. doi: 10.1136/bmj.f232. PMID: 23349407; PMCID: PMC3553934.
Harris, K., Driban, J. B., Sitler, M. R., Cattano, N. M., & Hootman, J. M. (2015). Five-year clinical outcomes of a randomized trial of anterior cruciate ligament treatment strategies: an evidence-based practice paper. Journal of athletic training, 50(1), 110–112. https://doi.org/10.4085/1062-6050-49.3.53
Weiler, R., Monte-Colombo, M., Mitchell, A., & Haddad, F. (2015). Non-operative management of a complete anterior cruciate ligament injury in an English Premier League football player with return to play in less than 8 weeks: applying common sense in the absence of evidence. BMJ case reports, 2015, bcr2014208012. https://doi.org/10.1136/bcr-2014-208012