I've torn my ACL. Do I need surgery?
What is my ACL (Anterior Cruciate Ligament)?
The ACL is a ligament that connects your thigh bone (Femur) to your shin bone (Tibia) and is one of the major stabilising ligaments in your knee. See Figure 1
How do I injure my ACL?
ACL injuries are most commonly injured during sports and physical activities particularly with:
· Sudden change in directions
· Pivoting with your foot planted
· Landing awkwardly
· Stopping suddenly
· Direct blow or trauma to the knee
How do I know if I tore my ACL?
Usually the diagnosis of an ACL tear can be confirmed with physical examination by your physiotherapist or GP. Your physio may occasionally refer you for an MRI to confirm the diagnosis of an ACL tear if there is a lot of swelling and pain. An MRI is generally not required to diagnose an ACL tear however can be useful to determine other joint injuries such as cartilage tears.
I have a torn ACL and my doctor says I need an ACL reconstruction…😟
The aim of treating someone with an ACL tear is to restore function, reduce symptoms such as pain, feeling of instability and swelling, improve quality of life and reduce future complications. It was believed that ACL reconstruction surgery would fulfil all these aims and therefore heavily advocated.
In recent years more high quality research has started to shed some light on whether early ACL reconstruction surgery is actually necessary. A study by Frobell et all compared young active patients who underwent an ACL reconstruction with patients who opted only for conservative treatment (i.e. physiotherapy) showed that both groups had the same functional scores and outcomes after 5 years. It is important to note that of those who had conservative treatment, 51% needed a delayed ACL reconstruction. “In other words about 50% of the patients will not need an ACL reconstruction if they are treated with structured rehabilitation… This study however does not apply to professional athletes as well as to patients who are involved in less than moderate activity.” (Dhillon K)
In a study by Neuman et al, showed that 77% of patients who were treated conservatively for an ACL tear did not require surgery after 15 years. Again, this does not apply to professional athletes and patients who are unwilling to reduce their level of activity.
Do I really need surgery?
You now know that in the mid term (5 years) there is no difference in the functional scores in young active patients treated with rehabilitation, early ACL reconstruction or delayed ACL reconstruction.
You also know that in the long term (15 years) only 23% of patients in the general population will need an ACL reconstruction.
It is best to speak to your physiotherapist, GP and orthopaedic surgeon to discuss whether surgery is actually required and not just opt for surgery.
Dhillon K. (2014). ‘Doc’ do I need an anterior cruciate ligament recontruction? What happens if I do not reconstruct the cruciate ligament? Malaysian Orthopaedic Journal, [online] Volume 8(3), page 42-47. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536400/ [Assessed 14 August 2020].