ACL TEAR RECOVERY [without surgery]

ACL TEAR RECOVERY [without surgery]

Anterior cruciate ligament (ACL) tears are a common sporting (or for some unlucky people, everyday life) injury.

The ACL is an important structure in the knee because it stops the moving over-rotating and giving-way.

To this day, most people who tear their ACL are told they will need an invasive surgical procedure called an ACL reconstruction to ensure their knee is stable in the future, and to prevent osteoarthritis. Research since the mid 1990’s has called these reasons into question, due to three key facts:

#1. People can develop knee stability with physiotherapy alone, over a 3-12 month period.

#2. The ACL can actually heal back together, and does so frequently.

#3. Surgery does not prevent knee arthritis in the long term.

Why recover without surgery?

  • ACL reconstruction involves bone drilling and cutting of healthy knee tissue. This is avoided with a nonsurgical approach

  • No risk of surgical infection

  • No risk of bleeding or numbness

  • No anaesthetic risks

  • Often a faster recovery (typical post surgery recovery is 12 months)

  • Less painful

  • Often substantially more cost effective

  • Potential for the ACL to heal on its own

  • No hospitalisation period

  • No risk of graft failure

  • Reduced environmental / carbon footprint

ACL essentials - start here with free guide - 6 top tips after ACL tear

FAQs

So, does anyone need surgery?

Of course, not everyone will be happy with the outcome of their knee after a period of rehabilitation. Surgery can be a helpful option for those who are experiencing ongoing knee instability (giving way) despite rehabilitation. However, a nonsurgical opinion should be sought first to ensure your rehabilitation has been optimal to avoid surgery and to ensure your expectations are realistic. There is no high quality evidence that delaying surgery is detrimental for knee health.

What if my Lachmann’s test is positive?

The Lachmann’s test is a test done by a physical therapist to assess for knee looseness in a particular position, with your muscles totally relaxed. It is useful to diagnose an ACL tear in the first place. Whether someone feels their knee is stable often does not correlate with a positive Lachmanns. This means that someone may continue to have a positive Lachmanns tests long after their injury, but can be happy with their knee stability.

I have been told surgery is a simple fix for my ACL tear, is this true?

No. The best way to understand what is involved in ACL surgery is to watch a video of the surgery being performed (not for the squeamish!)

Is the CROSS protocol the only or best way to heal an ACL?

The Cross protocol (see https://bjsm.bmj.com/content/57/23/1490) is a method of healing the ACL that involved bending the knee to a right angle for 4 weeks and slowly letting it straightening out. More than 10 studies on ACL healing have shown high rates of ACL healing, so the Cross protocol is only one method of healing the ACL. There is no data to date to suggest it is superior than other bracing protocols which are more practical. Many people are excluded from undertaking the Cross protocol due to strict inclusion criteria. Participants of the Cross protocol need to take blood thinning medication and be supervised by a sports physician.

I have had ACL surgery and torn my graft. Can I recover non-surgically?

Unfortunately, once an ACL graft is torn, revision surgery carries a higher risk than the first surgery of poor outcome. Therefore, many people are interested in a nonsurgical recovery. Thankfully many can recover without needing a second surgery, and it is even possible for the torn graft to heal. It is important to reassess your goals after a second knee injury as returning to pivoting sports carries a significant risk of a third injury, which would place your knee at a high risk of osteoarthritis.

Do I need to have surgery if I want to be very active again?

No! High quality research has shown that it is perfectly possible to return to sports without surgery. Rates of return to sport post surgery are not shown to be substantially different to nonsurgical management. It is best to discuss your return to sport goals with Michael as some sports carry higher re-injury risk than others. In general, the more demanding the sport you wish to return to, the longer the rehabilitation period.

Will I need to keep doing exercises for the rest of my life?

Studies have shown that even up to many decades after injury, nonsurgical rehabilitation can be a safe and effective option. The Office of Disease Prevention and Health Promotion recommends that people participate in resistance training twice a week. Doing this will aid in keeping your knee stable in the long term.

Will I be able to run again with a nonsurgical approach?

Highly likely, yes! With quality rehabilitation, running is a typical activity that people return to without surgery.

Do I need surgery to return to pivoting sport?

Pivoting sports such as football (soccer) and gridiron place a high demand on knee joints and have an increased risk of re-injury. There is no evidence that people are more likely to return to these sports if they have surgery, vs without. The key is in the quality of the rehabilitation you do. If after 3-6 months your knee is not presenting as stable, and you still desire to return to sport, surgery may be recommended.

What are the best exercises for an ACL tear?

The best exercises for you depend on your exact injury, goals, your stage of injury recovery, your pre-existing level of fitness and your knee signs and symptoms. Michael will be very glad to coach you through optimal exercise programs at every stage of your recovery.

I want to hear stories of nonsurgical recovery. Where can I find them?

Michael is the founder of the incredibly successful Facebook group “ACL and meniscus tear recovery without surgery” which has over 27000 members. Many recovery journeys have been documented in this group since its inception 2019.