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ACL Injuries: Does it always require surgery?

ACL Injuries: Does it always require surgery?
ACL Injuries: Does it always require surgery?

It’s the injury that many athletes fear the most: the dreaded ACL injury.

The ACL, or anterior cruciate ligament, is one of four major ligaments that controls the stability and mobility of the knee. It is also the ligament that is most commonly injured. The other three ligaments that keep the knee in its proper place are the medial collateral (MCL), the lateral collateral (LCL) and the posterior cruciate (PCL) ligaments. The ACL’s main responsibility is preventing the tibia from sliding too far forward, away from the femur. Without it, knee dislocation is only a wrong step away.

When the ACL is torn, it does not repair itself all on its own like other injuries tend to do, especially if other parts of the knee, like the meniscus, are damaged in the process. That’s a shame, since approximately 200,000 people tear their ACLs each year, usually by trauma in sports such as basketball, football, skiing and soccer. At this time, the injured man or woman must make a decision on whether to have surgery or not. The affected person can continue their day-to-day life without a proper functioning ACL.

But then why are there nearly 200,000 ACL reconstruction surgeries each year? The answer to this all depends on the person.

Physiotherapist Richard B. Frobell, Ph.D, and his team at Sweden’s Lund University performed two different treatments with 121 young, active individuals who had just injured their ACLs. Both groups went through a regimented rehabilitation program in which they improved on coordination and balance and worked into knee strengthening exercises.  Half of them underwent reconstructive surgery in the first 10 weeks, while the other half focused on rehabilitation only and put off surgery until it was apparent they needed it, or until it had healed.

Fast forward two years later, and both groups felt about the same towards their knee’s stability and condition.  Surprisingly, 60% of those who delayed surgery found that they never needed it.

“A lot of people say you need ACL surgery if you want to return to sports. But our results show we might be better off if we start with rehabilitation,” Frobell said. “Then we can reduce the number of people needing surgery.”

On the other hand, if the injury sustained in the knee includes more than just the ACL, immediate surgery may be the smartest choice.  “If you have a large meniscus tear and you fix the meniscus and not the ACL, there is a very high likelihood the ACL will fail,” Mayo Clinic orthopaedic surgeon Bruce A. Levy said about Frobell’s report.

The big deciding factor on the matter is the level of sports activity that the individual is involved with. A recreational swimmer or cyclist can most likely forego surgery and work on his or her rehabilitation. A professional, collegiate or even high school athlete who wants to get back in the game as soon as possible must most likely have surgery immediately. The average length of time to heal from ACL surgery is six to nine months, but that is the quickest way back to a potential full recovery.

An ACL surgery does not always guarantee the injury will not reoccur, and avoiding surgery does not guarantee the ACL will ever fully heal properly. It’s important to meet with your doctor and determine what’s best for you and your future.

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