I’ve torn my ACL! Do I need surgery?
ACL reconstruction surgery vs non-surgical rehabilitation
So, you’ve torn your ACL. Everyone from your mother to your dry cleaner will have an opinion on what to do. Even health professionals such as your doctor, physio or orthopaedic specialist may even have differing opinions on how you should proceed. It can get very confusing to know what’s best for you and your situation, so let’s start with the facts…..
Recent literature reviews comparing non-surgical rehabilitation and ACL reconstruction surgical groups, showed similar outcomes with respect to pain, function, return to sport, quality of life, subsequent meniscal damage, and radiographic knee osteoarthritis prevalence (Smith et al 2014, Delincé and Ghafil 2012, Monk et al 2016).
A Randomized Controlled Trial, the KANON (Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment) trial by Frobell and colleagues (2013), recommended that their results should encourage clinicians and young active adult patients to consider rehabilitation as a primary treatment option after an acute ACL tear.
Our cultural trends and confronting our beliefs?
Australia has the highest rates of reconstruction in the world. Our public and private healthcare models are set up to fund early MRI, early surgical opinion and early surgery. Physiotherapy and exercise as treatment and management of ACL tears is currently not routinely advertised, funded or recommended.
Clinicians and patients are simply unaware of the quality of the research. The KANON trial is liberating, hopeful and revolutionary in challenging our beliefs all ACL tears require surgery.
We need to confront any belief that an ACL Reconstruction is a quick fix (Zadro and Pappas 2018), there may be benefits of undertaking only immediate rehabilitation for at least 3 to 6 months, this approach has been termed ‘World’s Best Practice’ (Rooney 2018). The bottom line is for many active patients, non-surgical management will continue as a permanent, life-long solution and commitment.
Trauma of surgery?
It must be pointed out that early surgery causes secondary trauma, due to the surgical drilling through intra-articular structures, a period of prolonged joint inflammation and altered weight bearing follows (Bowes et al 2019, Larsson et al 2017).
ACL deficient knees means no sport!
No! It is a fallacy based on a biologically plausible theory, that you cannot return to sports involving pivoting or cutting type movements with an ACL deficient knee. There are plenty of peer reviewed papers that show returning to these types of sports is achievable and safe for many patients (Meuffels et al 2009, Grindem et al 2012, Kovalak et al 2018).
To be successful without surgery…
Factors for a successful outcome following non-surgical rehab, include commitment to the rehab program, strong performance of quadriceps strength and hop tests (Ericson et al 2013).
At Lilyfield Physiotherapy, we believe in following the research and where it is appropriate, we encourage patients to undertake a period of dedicated rehabilitation before considering major surgery, such as an ACL reconstruction.
If you have recently damaged your ACL Book an appointment with one of our experienced Physios to help guide you on the road to full recovery.