ACL Surgery – Making a Decision
The anterior cruciate ligament, or ACL, is one of four primary ligaments that provides stability to the knee joint. If the ACL is completely torn, it will not heal normally. Some individuals elect to leave the knee without a functioning ACL, and some choose ACL surgery to replace the torn ligament.
Left untreated, a knee with a torn ACL may have ongoing symptoms of knee instability. This is usually a sensation of buckling or the knee giving-out. For some people, this may not be bothersome, but for others, it may interfere with their activities. Determining if you should have ACL reconstruction surgery depends on a number of factors.
Do I Need ACL Surgery?
Making a decision to have ACL reconstructive surgery can be difficult. The surgery is not the only factor that needs to be considered, as the rehabilitation after surgery lasts a number of months, and full activity may be restricted for almost a year. Therefore, many people who sustain a torn ACL wonder if surgery is the best option for their situation. Here are some of the factors you may want to consider:
- Allows return to sports that require a functioning ACL
- May protect future damage to the knee cartilage
- Offers the potential for a normal functioning knee
- Surgery is not 100% effective — some people don’t fully recover
- Many activities can be performed without a normal ACL
- There are complications and risks of surgery
ACL reconstruction surgery should be considered for all individuals who desire a return to sports or activities that require lateral pivoting of the knee, or those who experience recurrent instability of the knee. ACL surgery is a good option for:
- Most people expecting to return to high-level athletic activities in sports such as soccer or basketball
- Individuals who experience recurrent episodes of knee instability due to ACL insufficiency
- Patients who do not want to attempt nonsurgical treatment
ACL Reconstruction Surgery
ACL reconstruction surgery is performed to create a new ligament to take the place of the torn ACL. There are a number of considerations for those who are interested in ACL surgery including the specific surgical technique, the timing of surgery, and the type of graft to use.
The surgical procedure is an outpatient procedure. Patients are given crutches to use, most often for a few weeks after surgery. Rehab after an ACL tear can take several months, and most doctors limit patients recovering from ACL reconstruction for 7-9 months after the time of surgery.
Non-surgical treatment of a torn ACL is focused on two areas. First is developing improved neuromuscular control of the lower extremity. Essentially you are training and teaching the muscles and tendons to support the knee joint as best possible. Neuromuscular control of the extremity can help people who have a nonfunctioning ACL and is thought to be the most critical factor in preventing ACL injury.
The second way to control knee stability with nonsurgical treatment is with the use of external supports, specifically custom ACL braces. These sports braces are custom fit and designed to be worn while participating in competitive sports activities. Some surgeons recommend these braces even after performing ACL reconstruction surgery, although this recommendation is controversial.
Most young, competitive athletes will choose to have surgical ACL reconstruction after sustaining an injury to the anterior cruciate ligament. However, there are times when someone may choose to have nonsurgical treatment. In general, surgery is best for those individuals who participate in lateral, pivoting sports (soccer, basketball, etc), and for those individuals who have signs and symptoms of knee instability in their activities.
- Sanders JO1, Brown GA, Murray J, Pezold R, Sevarino KS. “Treatment of Anterior Cruciate Ligament Injuries” J Am Acad Orthop Surg. 2016 Aug;24(8):e81-3.
- Shea KG, Carey JL. “Management of anterior cruciate ligament injuries: evidence-based guideline” J Am Acad Orthop Surg. 2015 May;23(5):e1-5.