Surgery is the default treatment for ACL injuries in Australia. But that’s not the only way

The anterior cruciate ligament (ACL) is a crucial ligament in the knee. It runs from the femur (thigh bone) to the shin bone (tibia) and helps stabilize the knee joint.

Injuries to the ACL, often called a “tear” or “crack”, are common in sports. While a torn ACL has just been sidelined one other star of MatildaPeople practicing recreational sports are also liable to this injury.

For a long time, the primary treatment method was surgical repair of an ACL injury, called reconstruction In Australia. In fact, Australia has amongst highest rate of ACL surgery in the world. Reports indicate 90% of individuals who tear their ACL go under the knife.

Although surgery is common – approx a million are performed yearly around the world – and while it appears to be the default treatment for ACL injuries in Australia, it might not be required for everyone.

What does the research say?

We know that ACL tears may be treated with reconstructive surgeryBut tests still suggests that for many individuals they may be treated with rehabilitation alone.

Nearly 15 years ago, a randomized clinical trial published in the journal New England Journal of Medicine compared early surgery with rehabilitation with the option of delayed surgery in young, energetic adults with ACL injury. More than half of the people in the rehabilitation group did not undergo surgery. After five years, knee function it was no different between treatment groups.

Since then, the results of this initial study have been supported by more research. AND review of three trials published in 2022 showed that delaying surgery and trial rehabilitation led to similar outcomes to early surgery.

AND 2023 study patients who underwent non-surgical rehabilitation were observed. It showed that one in three patients had evidence of anterior cruciate ligament (ACL) healing on MRI after two years. There is also evidence of improved knee-related quality of life in individuals with signs of ACL healing in comparison with those whose ACL showed no signs of healing.

Regardless of the alternative of treatment, the rehabilitation process after a rupture of the anterior cruciate ligament (ACL) is long. This often covers a minimum of nine months gradual rehabilitation performed several days every week. Rehabilitation times could also be barely shorter for individuals who do not undergo surgery, but more research is needed in this area.

Rehabilitation begins with physical therapist supervision of straightforward exercises, through to resistance exercises and dynamic movements reminiscent of jumping, skipping and agility exercises.

Rehabilitation can begin with the option of subsequent surgery if the knee stays unstable. A standard sign of instability is the knee bending when changing direction while running or playing sports.

Rehabilitate and wait, or go straight under the knife?

There are many the reason why patients and doctors may select early surgical reconstruction.

For elite athletes, the key issue is to return to sport as quickly as possible. Since surgery is a well known method, athletes (e.g Matilda Sam Kerr) often decide to undergo early surgical reconstruction since it provides a more predictable recovery timeline.

At the same time, the risks related to returning to sports after anterior cruciate ligament (ACL) reconstruction should be taken under consideration. ACL re-injury is quite common. For every month return to sport delayed until nine months after anterior anterior ligament (ACL) reconstruction, the knee re-injury rate is reduced by 51%.

Historically, one more reason for early surgical reconstruction was to cut back the risk of future knee osteoarthritis, which increases after an ACL injury. But review showed that ACL reconstruction does not reduce the risk of knee osteoarthritis in the long run in comparison with non-surgical treatment.

That said, there is a necessity for more long-term, high-quality studies that may allow us to raised understand how different treatments affect the risk of knee osteoarthritis.

Rehabilitation may not be the only non-surgical option

Last yr, test taking a look at 80 people wearing a specialized knee brace for 12 weeks, it was found that 90% had signs of anterior cruciate ligament (ACL) healing on a follow-up MRI.

People who had an MRI scan after three months showed higher treatment outcomes, including the next rate of return to pre-injury sports activity and higher knee function after 12 months. While this is promising, we now need comparative studies to evaluate whether this method can achieve results much like surgery.

What to do if you happen to tear your ACL

First, it is necessary to acquire a comprehensive medical evaluation from a sports physical therapist, sports physician, or orthopedic surgeon. ACL injuries can also involve injuries to the surrounding ligaments and cartilage, which can impact treatment decisions.

When it involves treatment, consult with your doctor the pros and cons of management options and whether surgery is obligatory. Patients often do not know that they can’t undergo surgery.

For some people, surgery seems obligatory to realize a stable knee. However, this is not obligatory in every case, so many patients should want to try rehabilitation first.

As all the time, prevention is key. The research have shown greater than half ACL injuries may be prevented by implementing preventive strategies. This includes performing specific exercises to strengthen your leg muscles and improve your movement control and landing technique.