Is Surgery Needed For My ACL Injury?Jo Clacher
Article by Zoe Russell
Is Surgery Needed For My ACL Injury?
The Anterior Cruciate Ligament (ACL) is one of the main stabilising ligaments of the knee. It contributes in conjunction with your muscles, other ligaments and receptors in the joint capsule and surrounding tissues to maintain the knee’s stability.
An ACL injury is often seen as a devastating injury, with treatment decisions often made in the timeframe early after injury, often favouring a surgical reconstruction.
Did you know – there are 3 options for treatment after you have injured your ACL?
- Early Surgical Reconstruction
- Delayed Surgical Reconstruction after 3 months of Rehabilitation
- Non – Surgical Management.
Evidence currently demonstrates that rehabilitation, with a decision regarding surgical intervention delayed until 3 months, may have the best long term outcomes in recreationally active individuals (Grindem et al., 2014). This is different to elite athletes, where we often see an early surgical approach.
Treatment choice differs in different populations, based upon the specific individual characteristics of the injured person and the available evidence that guides clinical practice (Ardern et al., 2014). Everyone who has injured their ACL should have a structured rehabilitation program, with testing conducted
How do you decide what to do?
Treatment choice is determined by several individual factors, specifically.
- Activity level
- There is good evidence to suggest that to remain recreationally active, and you may not require surgical reconstruction of your ACL injury (Frobell et al., 2010; Frobell et al., 2013)
- There is currently no research to suggest a non – surgical approach is successful in elite athletes (Frobell et al., 2013; Grindem et al., 2014).
- Current evidence suggests that if you wish to return to a sport that requires cutting or change of direction (known as Level I Sports), you may favour a surgical repair of your ACL injury. However, this should not stop you from completing pre-surgical rehabilitation before making a decision.
- Future Goals
- Having a specific understanding of where you are currently and where you want to be with your goals is an important consideration.
- Stability of the Knee
- Some individuals can stabilise their knee dynamically (i.e., with their muscles) in the absence of a deficient ACL. This can be determined by completing a prehabilitation program that involves preoperative testing and reassessment of testing outcomes across the duration of your prehabilitation program (Rooney, 2018).
- Concomitant Injuries
- Injuries to adjacent structures such as the menisci (shock absorbing component of the knee) and the articular cartilage (surface of the bone) may influence the treatment choice and timing of any intervention (Frobell et al., 2010).>
- Past History
It is recommended that a shared decision-making process occurs between yourself, your Physiotherapist and your Orthopaedic Specialist (Ardern et al., 2014). This involved outlining all the options relative to your presentation and discussing all options to facilitate your rehabilitation and recovery plan! It is also strongly recommended that you have thorough outcome testing pre-intervention, during rehabilitation, and return to sport (Ardern et al., 2011; Grindem et al., 2017; Webster, 2020). These tests include physical tests, psychological screening specific to ACL injury and Quality of Life measures related to your injury (Ardern et al., 2015).
Research in this area is constantly evolving, and you must seek assistance from a Physiotherapist who is up to date with current with the latest research! Your PhysioWorks Physiotherapist can help discuss all these options. Best results have been shown when you start your rehabilitation program early, despite the chosen treatment strategy.
PhysioWorks offers prehabilitation and rehabilitation programs that are individualised and specific to your sport and your injury. As part of the rehabilitation program, we conduct testing to ensure that you are on track with your recovery to achieve your goals and communicate this directly with your treating specialist as required.
PhysioWorks offer same-day appointments for the prompt diagnosis and rehabilitation plan.
ACL TearAn ACL (Anterior Cruciate Ligament) tear most often occurs during sporting activities when an athlete suddenly pivots, causing excessive rotational forces on the ligament. Individuals who experience ACL tears describe a feeling of the joint giving out or buckling. You'll commonly hear a "pop."
Signs You May Have Sustained an ACL Tear:
- Sudden giving way of the knee
- Hearing a 'pop' at the time of injury
- Sudden swelling of the knee joint
- Pain in the knee when walking
How is an ACL Tear Diagnosed?A well trained Sports Physiotherapist, Sports Physician or Orthopaedic Surgeon will generally be able to confirm the diagnosis of an ACL tear within the clinic and from your injury history. An MRI scan can confirm your ACL tear and identify other knee injuries that may have occurred when your ACL was ruptured. These accessory injuries commonly include meniscal tears, bone bruising and collateral ligament injuries. Confirmation of an ACL tear is essential since the treatment differs from a common knee ligament strain or a meniscus tear.
What to do if you have a Ruptured ACL?Please be guided by your trusted healthcare practitioner for an ACL tear. Successful rehabilitation options vary depending on your age, activity level and extent of the injury. For specific advice, please consult an experienced knee physiotherapist, knee surgeon or sports doctor.
More info:ACL Injury Is Surgery Needed For My ACL? Posterolateral Corner Injury Knee Ligament Injuries
Why are ACL Tears Such a Big Problem?When an ACL injury occurs, the knee becomes less stable. The ACL injury is a problem because this instability can make sudden, pivoting movements difficult, and it may make the knee more prone to developing arthritis and cartilage tears. If your knee is unstable, a common complaint of a sensation that the knee will 'give out' from under them. When this giving way sensation is because of an ACL injury, the knee joint is sliding too much. Joint sliding can be a problem because each episode of instability (the 'giving way' sensation) can cause damage to the knee cartilage. Therefore an ACL injury makes patients more prone to developing arthritis and meniscus tears. Athletes often have particular difficulty once they have sustained an ACL injury. Many sports require a functioning ACL to perform common manoeuvres such as cutting, pivoting, and sudden turns. These high demand sports include, but are not limited to:
- Snow Skiing
- Hockey (Ice and Field)