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Is ACL Surgery Necessary?

ACL tears are a common knee injury among athletes, from professionals to weekend warriors. In the last two decades, if you suffered an ACL tear and wanted to resume an active lifestyle, surgery was necessary. Recent research now challenges this presumption. How can you decide if surgery is right for you?

The ACL ligament is one of the main ligaments that help stabilize the knee. It is located in the center of the knee joint and helps control rotational motion. For those involved in sports, both contact and non-contact, ACL injuries are common. Female athletes are even at great risk of sustaining an ACL injury as they tend to be quadridominant and lack lateral hip strength, which helps limit knee rotation.

Over the past two decades, significant progress has been made in ACL reconstructions. Is no longer and an ACL injury is considered a career ending injury. Now, ACL reconstructions have progressed to allow most of the surgery to be performed arthroscopically with a return to athletic activity within six to nine months.

However, the surgery is not without complications. Anterior knee pain associated with patella tracking issues, knee swelling, stiffness, and even arthritis can all be potential complications. Additionally, a small percentage of those who undergo ACL reconstruction have their reconstructions fail.

One of the reasons ACL surgery is recommended is the possibility that instability of the knee may lead to an increased risk of cartilage damage and the early onset of arthritis in the future. Also, for those wishing to return to an active lifestyle, the presumption is that without the ACL, the knee will feel unstable.

For those who wanted to regain their previous level of activity after sustaining an ACL tear, surgery was usually presented as the only option. A new research study, published in the New England Journal of Medicine, now challenges that assumption. The two-year study evaluated 121 active young adults after 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 delayed reconstruction. Of the 59 participants in the rehabilitation-only group, 36 did not have to undergo ACL reconstruction. The study found that there was no significant difference between the two groups in the ability to return to the previous activity level.

This study is one of the first in recent years to assess the need for ACL surgery. Based on the study, those in rehabilitation without surgery were able to return to prior activity levels equal to those in the surgical group. This study significantly challenges the need for early ACL reconstruction. Although more studies are needed to determine the long-term consequences of rehabilitation alone, this study offers options for people with ACL tears.

If you have suffered an ACL injury, discuss the options of surgery versus rehabilitation with your doctor. You may not have to undergo ACL reconstruction to resume the activities you enjoy.

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