So you’ve torn your ACL... Is surgery the only option?

What is a torn ACL?

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The anterior cruciate ligament (ACL) is a ligament in the knee that is responsible for its stability in multiple positions. The ACL helps to prevent excessive movement of the lower leg on the upper leg, excessive hyperextension of the knee and rotation of the lower leg. (1) Tearing of the ACL will often occur during activities that include pivoting, sudden deceleration and change of direction. After tearing an ACL there are two treatment options, surgery to replace the torn ligament, or conservative management. (2)

What can I do about my ACL?

The decision in picking an option should not be taken lightly and options should be discussed with your physiotherapist and knee specialist. Surgical management has been generally suggested for those with a high degree of instability, have associated knee injuries, has a desire to return to sport or has an occupational need for knee stability. Conservative management (physiotherapy with a structured rehabilitation program) is suggested for those who will not require a high degree of knee stability. (2)

Although these guidelines are necessary for the majority of individuals with a torn ACL, it has become recently apparent that not everyone who receives ACL surgery needs it. Australia has one of the highest ACL injury and reconstruction rates in the world (3), however this high rate may not be necessary. Undergoing conservative management does not increase your rick of osteoarthritis (4) or prevent a return to sport (5,6). It has also been shown that at 2 years post ACL injury, conservative management and surgery result in similar knee function. (2)

So, if you sit in the grey area of the recommendations or you don’t want to undergo surgery then how do you know you could cope well without an ACL?

Copers vs non-copers

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A coper is an individual who has good knee stability and function after injury, whereas non-copers have more instability and altered function. Currently, the best way to predict a coper is through knee function after 1-3-months of conservative rehabilitation. (2,6,7) This timeframe allows a practitioner to assess if you could cope well without an ACL.

After at least five weeks of structured rehab, we will perform screening tests that assist in predicting a coper vs a non-coper. The team at Thornleigh Performance Physiotherapy are well trained to manage ACL injuries from initial trauma to return to sport understanding both the surgical and non surgical routes.

If you have any questions regarding your ACL management options, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, and to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.

References

  1. Liu-Ambrose T. The Anterior Cruciate Ligament and Functional Stability of The Knee Joint, BCMJ. 2003; 45 (10): 495-499

  2. Brukner P. Brukner and Kahn’s Clinical Sports Medicine. 4th Edition. McGraw-Hill Australia; 2012.

  3. Zbrojkiewicz D, Vertullo C, Grayson J. Increasing Rates of Anterior Cruciate Ligament Reconstruction in Young Australians. Med J Aust. 2018; 208 (8): 354-358. 

  4. Yperen D, Reijman M, Van Es E, Bierma-Zeinstra S, Meuffels D. Twenty-Year Follow-Up Study Comparing Operative Versus Nonoperative Treatment of Anterior Cruciate Ligament Ruptures in High-Level Athletes. Am J Sports Med. 2018;46(5):1129-1136.

  5. Grindem H, Eitzen I,Moksnes H, Snyder-Mackler L, Risberg M. A Pair-Matched Comparison of Return to Pivoting Sports At 1 Year in Anterior Cruciate Ligament-Injured Patients After a Nonoperative Versus an Operative Treatment Course. Am J Sports Med. 2014; 40(11):2509-2516

  6. Grindem H, Wellsandt E, Failla M. Anterior Cruciate Ligament Injury—Who Succeeds Without Reconstructive Surgery? The Delaware-Oslo ACL Cohort Study. Orthop J Sports Med. 2018; 23;6(5).

  7. Fitzgerald G, Axe M, Snyder-Mackler L. A decision-making scheme for returning patients to high-level activity with nonoperative treatment after anterior cruciate ligament rupture. Knee Surg, Sports Traumatol, Arthrosc (2000) 8 :76–8

  8. Hurd W, Axe M, Snyder-Mackler L. Management of The Athlete with Acute Anterior Cruciate Ligament Deficiency. Sports Health. 2009; 1(1): 39-46

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