ACL Reconstruction vs Exercise Management

ACL Reconstruction vs Exercise Management

Article by Zoe Russell

ACL Injury

Is Surgery Your Best Option?

ACL Reconstruction vs Exercise Management

Research Finds Rehab-Only Treatment – Superior Long-Term Results


Researchers have found that knee reconstructions for ACL deficient knees may lead to more problems later in life than non-surgical rehabilitation. A team led by Dr Adam Culvenor from La Trobe University looked at health outcomes for athletes with damaged anterior cruciate ligaments (ACL) – a devastating injury ubiquitous among footballers.

ACL injuries require lengthy rehabilitation and up to 12 months on the sidelines. However, many athletes also opt for surgery to reconstruct the torn ligament, hoping that this will get them back to sport sooner and prevent the development of knee arthritis.

To test the efficacy of this approach Dr Culvenor and colleagues from Lund University in Sweden and Paracelsus Medical University in Austria conducted analyses on a world-first clinical trial involving 117 ACL injured athletes.

The participants were either given surgical reconstruction within ten weeks after the injury or non-surgical rehabilitation with the option of having a knee reconstruction later in life. They monitored progress for five years.

Magnetic resonance images (MRI) of the affected knee joints revealed that those who had undergone early surgery experienced a more significant loss of kneecap cartilage – a principal cause of arthritis.

“These findings challenge existing beliefs that reconstruction surgery is required to prevent early arthritis in young adults following ACL injury,” says Dr Culvenor.

“Indeed, early surgery was actually detrimental to knee joint health. We suggest that reconstruction surgery should not be used to prevent arthritis in young adults with an ACL injury. It may lead to more young people developing ‘old knees’.”

The research was recently published in the British Journal of Sports Medicine.

Further Reading:

Culvenor AG, Eckstein FE, Wirth W, Lohmander LS, Frobell R. Loss of patellofemoral cartilage thickness over 5 years following ACL injury depends on the initial treatment strategy: results from the KANON trial. British Journal of Sports Medicine. 2019 doi:10.1136/bjsports-2018-100167

What is your ACL?

Common Causes - Knee Pain

Knee pain can have many origins from local injury, referred pain, biomechanical issues and systemic issues. While knee pain can appear simple to the untrained eye, a thorough assessment is often required to ascertain the origin of your symptoms. The good news is that once a definitive diagnosis is determined, most knee pain quickly resolves with the correct treatment and rehabilitation.

Knee Ligament Injuries

Knee Meniscus Injuries

Kneecap Pain

Knee Arthritis

Knee Tendon Injuries

Muscle Injuries

Knee Bursitis

Children’s Knee Conditions

Other Knee-Related Conditions

Knee Surgery

Knee FAQs

For specific information regarding your knee pain, please seek the assistance of a healthcare professional with a particular interest in knee condition, such as your knee physiotherapist.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.


If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  


Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.


Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.