If you’ve had a cruciate ligament injury or even ruptured your ACL, surgery is not your only option. In fact, upon injuring your ACL, it is the world’s current best practice according to the research to undergo an intense, structured, supervised exercise program for a period of at least 3-6 months, prior to considering your suitability and desire for surgery.
Non-operative ACL treatment including Physio is as good as surgery
Recent literature reviews have found similar outcomes in both non-surgical (physiotherapy) and surgical groups with respect to pain, symptoms, knee function, return to sport levels, quality of life, subsequent meniscus injury and surgery rates, and radiographic knee joint osteoarthritis (OA) prevalence.
According to this study which looked at the underutilization of rehabilitation after anterior cruciate ligament reconstruction, there is a lack of research demonstrating any additional benefit of ACL reconstruction after an anterior cruciate ligament rupture when compared to physiotherapy and exercise rehabilitation, highlighting the “emerging realisation that athletes may be overtreated with ACLR surgery, but undertreated when it comes to rehabilitation”.
As such and according to this study, there needs to be a cultural shift from early surgery toward non-surgical management, with surgery “as needed”.
The ACL can heal, but if it doesn’t, it can become redundant
There are a number of studies demonstrating that if left alone, anterior cruciate ligaments can heal, and full-thickness tears can reunite. This study evaluated ACL healing using MRI within 5 years of ACL rupture, with 58% of patients having a healed ACL at a 5-year follow-up.
As mentioned above, even if it doesn’t heal, through the intense strengthening of the lower limb, including balance and proprioceptive work, the ACL can become redundant and you may be able to return to your usual activities without hindrance.
What is the world’s ‘best practice’ after injuring your ACL?
According to this study in 2017, as well as this study in 2019, individuals who undergo quick and early ACL reconstruction are “prognostically worse across multiple domains compared to the non-surgical and delayed surgical groups, suffering a ‘second trauma’ due to the surgical drilling through intra-articular structures, a period of prolonged joint inflammation and altered weight bearing”.
As such, by starting with physiotherapy rehabilitation for a 12-24 week period, you’re assured of a superior outcome either way – whether you end up having surgery or not.
The sooner you can get started with physiotherapy after a cruciate ligament tear or injury, the more likely you are for a good outcome in the long term.
If this is all true, why is surgery so common?
Society has been conditioned over a long period of time to be alarmed and devastated when a player injures their ACL during a sporting contest. You’ll often hear sporting commentators verbalising they’re fearing the worst about a player’s knee injury. With this emotion comes the assumption the athlete has injured their ACL and surgery is a must, meaning they will need 9 to 12 months off their sport.
This narrative is false, and needs to be replaced with a rational explanation of what the research suggests – that many can have their knee function at the elite level without the need for invasive surgery and non-operative treatment is equally as viable as operative management. You can read more about pre and post-operative rehabilitation here.
What does rehabilitation look like for someone who doesn’t want to have surgery?
The early to mid-phase of rehabilitation after an anterior cruciate ligament rupture focuses around normalising your walking patterns, reducing pain and swelling, and improving and regaining your knee range of motion, muscle strength and function. The quicker and earlier this process occurs, the better your knee will feel.
The end stage of rehabilitation includes jumping and plyometric work, change of direction, acceleration, agility, coordination, balance, endurance and sport-specific skills, as well as running and sprint programmes where required.
Once formal rehabilitation is completed, it is recommended to follow up with an ACL injury prevention program implemented and completed indefinitely. You can read more about the importance of injury prevention programs here.
So I could return to sport without surgery?
You certainly could. There is in fact not a single study that shows you can’t return to twisting sports without an ACL, whilst research, including the following studies in 2009, 2012 and 2018 for non-operative management shows that it’s achievable and safe for many patients to return to cutting and pivoting type sports.
For a great summary of all the available evidence in an easy-to-watch video, see below. In the meantime, if you’d like to book an initial consultation to discuss your treatment options after injuring your ACL, hit the ‘book online’ button above.
Thrive Physio Plus Adelaide is a leading provider of non-operative ACL management. For more information or to chat with one of our expert non-operative ACL rehabilitation Physios, call the clinic on 8490 0777, for a no-obligation chat.