Is ACL Surgery Necessary?

ACL tears are a common knee injury among athletes, from professional to weekend warriors. Over the past couple of decades if you sustained an ACL tear and wanted to get back to an active lifestyle, surgery was required. Recent research now challenges that presumption. How can you decide if surgery is right for you?

The ACL ligament is one of the main ligaments that assist in stabilizing the knee. It is located in the center of the knee joint and assists in controlling the motion of rotation. For those involved in sports, both contact and non-contact, ACL injuries are common. Female athletes are even at a great risk of sustaining an ACL injury because they have a tendency to be quad dominant and lack lateral hip strength that helps to limit knee rotation.

Over the past two decades, significant strides have been achieved in ACL reconstructions. No longer is and ACL injury considered a career ending injury. Now, ACL reconstructions have progressed to allow most of the surgery to be performed arthroscopically with a return to sport activity within six to nine months.
However, surgery does not come without its complications. Anterior knee pain associated with patella tracking issues, knee swelling, stiffness, and even arthritis can all be potential complications. In addition, a small percentage of those that undergo ACL reconstruction have their reconstructions fail.

One of the reasons that ACL surgery is recommended is the potential that knee instability will lead to future increased risk of cartilage injuries and the early onset of arthritis. In addition, for those wishing to return to an active lifestyle, the presumption is that without the ACL, the knee will feel unstable.

For those wishing to return to their previous level of activity after sustaining an ACL tear, surgery was generally presented as the only option. A new research study, reported in the New England Journal of Medicine, now challenges that assumption. The two year study evaluated 121 young active adults following sustaining an ACL tear. The participants were divided into two groups. One group had rehabilitation followed by early ACL reconstruction. The second group underwent rehabilitation with the option of a delayed reconstruction. Of the 59 participants in the rehabilitation alone group, 36 did not have to have ACL reconstruction. The study found that there was no significant difference between the two groups in the ability to return to prior level of activity.

This study is one of the first in recent years to evaluate the need for having ACL surgery. Based on the study, those undergoing rehabilitation without surgery were able to return to previous levels of activity equal to the surgical group. This study significantly calls into question the need for early ACL reconstruction. Although more studies need to be performed to determine the long term consequences of rehabilitation alone, this study provides options for those with ACL tears.

If you have sustained an ACL injury, discuss with your doctor the options of surgery vs. rehabilitation. You may not have to undergo ACL reconstruction in order to return to the activities you enjoy.