ACL surgery no longer a requirement after a full thickness tear?

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When someone tears their ACL, often the first question they will hear is “when are you going for surgery?” For years it has been the first point of call to manage this injury, and this belief that it is an automatic requirement is still very prevalent in today’s society.

How do we know that ACL surgery is effective in the first place?

Well, we actually don’t have any research that has compared the reconstructive surgery against placebo surgery. There have been other musculoskeletal surgeries, such as shoulder impingement surgeries, that have been tested against a placebo, and found to be no better than sham surgery! So because ACL reconstruction has not been put through this same testing, we can’t say for sure that the outcomes you get from the surgery aren’t just from the placebo effect.

So what do we know about how to manage ACL injuries?

In 2013, there was a study conducted by Frobell et al. that looked at how the surgery compared to just high quality rehabilitation alone without the surgery. The results? They found that rehab alone was just as good as having the surgery. The information is best summarised by their concluding comments:

“In this first high quality randomised controlled trial with minimal loss to follow-up, a strategy of rehabilitation plus early ACL reconstruction did not provide better results at five years than a strategy of initial rehabilitation with the option of having a later ACL reconstruction. Results did not differ between knees surgically reconstructed early or late and those treated with rehabilitation alone. These results should encourage clinicians and young active adult patients to consider rehabilitation as a primary treatment option after an acute ACL tear.”

Not everyone will be a good candidate for a non-surgical approach, but on the other hand not everyone needs surgery after a complete ACL tear. The recommendation for the current best practice is to perform at least 3-6 months of high quality, individualised rehabilitation, before considering surgical intervention.
Rehab alone is more cost effective, can result in quicker return to sport timeframes, and does not carry the same risks of undergoing surgery.

If you’d like to know if you would suit a high quality, non-surgical approach, feel free to reach out to Ben at ben@physiowest.net.au to have a chat or book in with him online via the links below.

References:
Frobell, R. B., et al. (2013). “Treatment for actute anterior cruciate ligament tear: five year outcome of randomised trial.” British Journal of Sports Medicine 49(10): 700-700.

 


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