What Happens If You Don’t Get Surgery On Your ACL?

Article by Zoe Russell

What Happens If You Don’t Get Surgery On Your ACL?

When you have injured your Anterior Cruciate Ligament (ACL), the widespread assumption is that the only treatment plan is to have a surgical ACL reconstruction. However, emerging evidence shows that you do not need to have a surgical procedure in some cases. In some cases, people who choose not to have surgery immediately after their injury may have better long-term outcomes.

The best evidence for managing your ACL injury is to complete three months of rehabilitation under your physiotherapist’s guidance and then decide if surgery is required based on several factors. The research shows that if you can reduce the swelling, improve your strength and your neuromuscular control of your knee, you may be suitable to continue with your life and activities with your ACL not remaining intact. The current best evidence for recreationally active people is a three month trial of rehabilitation. A shared decision is made about the best action plan for yourself individually, in conjunction with yourself, your Physiotherapist and your Orthopaedic Specialist.

In these cases, you complete a progressive rehabilitation program that encompasses:

  • Phase One:
    • Reduce Swelling
    • Regain muscle control of the knee – specifically, Quadriceps, Hamstrings and Gluteal muscles
    • Retrain any difficulties with walking
  • Phase Two:
    • Progression of Strength
    • Introduce Neuromuscular Control activities
  • Phase Three:
    • Progress Strength Program to Power program
    • Start Straight Line Running
    • Initiate slow speed change of direction and jumping training
  • Phase Four:
    • Continued Strength and Power
    • Progression of Dynamic activities – modified versions of your chosen sport and activity
  • Phase Five (After Stringent Testing across all domains)
    • Return to Sport
    • Long Term Injury Risk and Performance Enhancement Programming

Suppose you have difficulties progressing within this ACL rehabilitation or have problems with instability or your knee giving way. Your physiotherapist may suggest that you return to see your Orthopaedic Specialist. The most common reason for this step would be frank instability, where the knee gives way without warning.

If you pass your functional tests to assess your suitability for returning to sport without an ACL being intact, you are good to go! There is now emerging evidence that the ACL can heal over time, and if you can regain the function of your knee to tolerate the daily demands of your life and your sport, you may not have to have surgery, AND your ACL may heal! In essence, the testing demonstrates that your muscles can support the knee in what it needs to do and react appropriately without the extra sensory input from the ACL.

To discuss non-surgical management of your ACL, please get in touch with your local PhysioWorks clinic. One of their experience knee physiotherapists can review your specific case and advise whether non-surgical management is appropriate for your needs!

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