Anterior cruciate ligaments tear - is surgery the only option?

Knee injury is common in athlete. One injury that is regularly heard on the news or on a family table discussion is anterior crucial ligament (ACL) rupture or tear.

Knee injury is common in athlete. One injury that is regularly heard on the news or on a family table discussion is anterior crucial ligament (ACL) rupture or tear.

What is an anterior crucial ligament?

anterior crucial ligament

ACL is one of the ligaments that helps to support the knee joint and provide feedback to the knee for sporting movement control. It is most commonly tore or rupture during a pivoting sports when the leg bone ( tibial) is anchored on the floor and the thigh bone ( femur) is rotated into the opposite direction or when a player is running and suddenly stops with the knee ending up in a hyperextended position.

Once the ligament is ruptured, the common belief is to pursue a surgical option to replace the ligament with a hamstring tendon or patellar tendon graft. Rehabilitation is often only commenced once surgery is completed, however it would require 9 to 12 months of post-operative rehabilitation prior to anyone returning to a sporting field. Recent research study has suggested that surgery is not always the best option for ACL tear management.

1. Surgery does not reduce risk of osteoarthritis or knee degenerative changes compared to physiotherapy rehabilitation.

Studies looked into long term consequences (up to 20 years) of different management pathways on knee cartilage changes and bony structures after ACL rupture have found that the cartilage thickness and degenerative changes in the knee are the same regardless of the management pathway.

2. Physiotherapy rehabilitation can improve function or pain as well as surgical management.

Physiotherapy treatment can effectively reduce pain and improve function without the expensive cost and risk of surgery by directing individuals a progressive exercise program. Based on several research studies that were done on high level athletes across the world, they found that those who have gone through surgical pathway and physiotherapy rehabilitation program have the same functional outcome and pain level after 2, 5 and 10 years time. Those who only completed physiotherapy rehabilitation were able to return to previous sports level as well as those who had surgery.

3. Complete ACL tear can potentially heal without surgery.

There has been cases and reports that show ACL rupture or complete tear can reconnect by forming new scar tissue. Overtime a new ligament is formed as collagen and fibrous tissues are lined down to the ruptured site and the knee can be as structurally stable as before injury.

4. Surgery has a significantly higher risk than conservative management.

Surgery creates surgical incision and open wound. It carries a risk of infection, bleeding, poor wound healing, graft failure, nerve damage and blood clot.

‘Surgery is not always necessary nor means better outcome’

For these reasons, conservative management should always be considered as the first line treatment. Our physiotherapists are highly trained clinicians with an extensive experience in managing ACL tear. They can provide a comprehensive assessment and management plan to assist you safely returning to your previous level of function and achieve your life goals. The treatment that we provide for ACL rehabilitation generally involves:

  • Pain and swelling management

  • Knee strapping

  • Strength and conditioning program

  • Balance exercise

  • Proprioceptive training

  • Return to sports program

  • Brace prescription and recommendation

If you would like to discuss further of your individual needs and concern about your ACL injury, please contact us to book into seeing one of our experienced and friendly physiotherapist to help you to get back on your feet.

If you would like to book in to see one of our physiotherapists, please press on the following link: Book now for your journey to recovery.