Does an ACL Injury Mean Surgery is in My Near Future?

Ah, the dreaded ACL injury … a nightmare scenario for active people – from the professional athlete to the high school soccer star to the weekend warrior. Consider this: Approximately 200,000 ACL-related injuries occur each year in the U.S. and about 100,000 ACL reconstructions are performed on an annual basis.

The anterior cruciate ligament (ACL) – whose primary job is to stabilize the knee – is a complicated ligament and prone to injury, especially in those who participate in high-impact sports such as soccer, football, basketball and skiing. What causes an actual ACL tear? Well, it’s usually due to an abrupt twisting motion when a person suddenly stops to change direction, twisting the wrong way upon landing from a jump or traumatic impact to the knee. The injury itself comes with a popping sound shortly followed by swelling and instability in the knee.

When the ACL is torn, it’s unable to fix itself on its own, especially if other parts of the knee are also damaged. A common question I am asked by patients, friends and family alike is, “do I have to undergo surgery to fix the problem or can I live with it?” My answer is that it all depends on the individual. In short, yes, you can live with a torn ACL, but will it negatively impact your everyday life? The level of activity you like to engage in usually helps in determining if ACL surgery is right for you.

My general rule of thumb is as follows:

• If the knee injury includes more than just a torn ACL, surgery is likely your best option. About half of ACL injuries occur in conjunction with damage to other parts of the knee, specifically the meniscus, articular cartilage, and/or multiple ligaments. In these types of combined injuries, surgical treatment yields better outcomes.
• If you are an athlete or a highly active person that wants to continue to perform your sport or activity to its fullest, ACL reconstruction surgery is for you. While the average healing time following ACL surgery is 6-9 months, it is the quickest option for full recovery.
• If you have a job that requires heavy manual work, you may want to consider surgery – particularly if the job requires use of ladders or moving on uneven ground.
• Certain isolated ACL tears can be managed with physical therapy and bracing alone. The best candidates for non-surgical ACL treatment includes those with:
  • Partial ACL tears
  • No signs or symptoms of knee instability when engaging in low-demand activity (i.e., biking, jogging or swimming) and who are willing to give up high-demand sports and intense activity (i.e., basketball, skiing, high-intensity exercise)
  • Those who lead a fairly sedentary lifestyle
  • Children whose growth plates are still open (if surgery is needed in these cases it is often delayed until the bones are fully formed)

However, it is important to know that people who decide against surgery are more susceptible to recurring instability episodes that can cause secondary knee injuries. These injuries usually involve damage to the joint cartilage or meniscus and can lead to early arthritis down the road.

Bottom-line? It’s not a one-size-fits-all approach. You’ll want to sit down with your orthopaedic surgeon and weigh your options to determine what’s best for you.

Good news, though! Research shows that the risk of ACL injuries can be limited by doing regular exercises that strengthen the muscles that stabilize the knee. For more information and exercises to help prevent ACL injuries, check out the below video

And if you’ve recently undergone ACL surgery, check out the below video to supplement your physical therapy.

Dr. Matthew Boes is a fellowship trained orthopaedic surgeon specializing in sports medicine. He serves as team physician for the NC State University football team. His areas of expertise include sports medicine, shoulder arthroscopy, knee arthroscopy and reconstructive surgery of the shoulder, elbow and knee. For more information on Dr. Boes click here