To Cut Or Not To Cut
The decision to choose elective surgery and have an ACL reconstruction surgery is not always a straight forward one.
After a complete ACL tear, many individuals are unable to participate in cutting or pivoting-type sports due to instability, while others have instability during even normal activities, such as just walking. There are however some rare individuals who can participate in sports without any symptoms of instability.
Despite the operation typically being considered a successful surgery with most patients having the symptomatic instability of their knee eliminated post surgically and with low complication rate not everyone who ruptures their ACL goes on to make the decision to actually have reconstructive surgery.
Extended Rehabilitation Process
One of the biggest barriers I find when talking to patients about undergoing an ACL reconstruction surgery is the significant time frame post surgically involved in returning to sport or pre injury functional levels. The rehabilitation program is quite involved with typically around at least 8-12 post surgical visits with your physiotherapist over a period of 9-12 months and a significant progressive home exercise program and sport specific training during the course of recovery.
ACL Reconstruction Surgery: Management Of ACL Tears
The younger active adult or more serious athlete in my experience will almost certainly always elect to have the surgery, especially individuals playing sports involving rapid changing of direction and pivoting such as the football codes and netball requires. The surgery gives the athlete a clinically and subjectively more stable knee better allowing them to comfortably perform those cutting and pivoting actions. Generally activity, not age, should determine if surgical intervention should be considered.
Nonsurgical Management Of ACL Tears
Typically people choosing not to undergo an ACL reconstruction surgery are the less active individual. If you are not currently involved in and are unlikely to be involved in the future in regular sport or activities involving a lot of rotational changes of direction and pivoting then you may well decide not to undergo reconstruction surgery.
However remembering that when someone ruptures their ACL frequently the ACL rupture is not the only injury they sustain at the time, it is suggested approximately 50 percent of ACL injuries occur in combination with damage to the meniscus, articular cartilage, bruises of the bone beneath the cartilage surface or other ligaments. As a result surgery may or may not be recommended more strongly due to the amount of “collateral damage” to the knee existing as well as the ACL injury itself and your desired or required activity level.
A patient with a torn ACL and significant functional instability has a high risk of developing secondary knee damage and should therefore consider ACL reconstruction.
It is possible secondary damage may occur in patients who have repeated episodes of instability due to ACL injury and in patients with chronic instability their risk of meniscal and articular cartilage damage years down the track are significantly increased if you remain ACL deficient electing against having the surgery.
Possible Nonsurgical Management Candidates
Individuals with partial tears and no instability symptoms.
Individuals with isolated complete tears but without symptoms of knee instability during low-demand sports and the person is willing to give up high-demand sports.
Individuals living sedentary lifestyles or doing only light manual work.
Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance on ACL Reconstruction Surgery should consult his or her orthopaedic surgeon, general practitioner or physiotherapist.