Do All ACL Tears Need Surgery?

The knee is a complex and weight-bearing joint structure that bears the brunt of most of our activities during the day. Over time, the four ligaments in the knee as well as the cartilage in the joint can begin to weaken and degenerate. Sudden movements, strenuous activities or injuries can cause a tear of a ligament in the knee – most commonly the Anterior Cruciate Ligament or ACL. This ligament runs diagonally across the middle of the knee and serves to keep it stable when we make turning or cutting movements, especially in sports.

ACL injuries are very common, and many patients may know immediately that they have injured or torn the ligament. While the initial injury creates pain, swelling and instability in the knee, some patients continue to push through causing more damage. Therefore, a prompt visit to an orthopedic surgeon is important. Partially torn ACLs often respond well over the course of a 3- to 6-month rehabilitation program. Some patients still experience instability even after this time. However, a complete tear of the ACL tends to have poor outcomes without surgery.

Does That Mean All Complete ACL Ruptures Require Surgery?

Not exactly. The first consideration when evaluating a patient for ACL surgery is what their expected activity level will be. If they do not intend to participate in sports that would require cutting movements, they may be able to proceed without surgery, possibly only needing a stability aid, such as a knee brace.

Rarely, a patient can perform all their normal activities even with a torn ACL, experiencing minimal or no instability, however this is most definitely the exception, not the rule.

Yet others, will experience instability of the knee even when doing normal daily activities or non-cutting sports. The degree to which this instability interferes with their lifestyle will go a long way in determining whether surgery is indicated.

Longer-term, patients with an ACL injury may have repeated episodes of instability in the knee affecting surrounding structures including the meniscus or cartilage. If the surrounding structures are damaged, knee pain and disability may occur, and surgery may be inevitable. Further, if the patient experiences a combined injury – for example an ACL tear and a meniscus tear, surgery is usually the best course of action.

Children whose growth plates are still open are less likely to undergo surgical repair of an ACL tear due to the potential for stunted growth.

Is Surgery a Safe and Effective Option?

When a patient comes to us looking to have their ACL reconstructed, we first make sure that they are a good candidate for a safe surgery. Generally speaking, surgery to rebuild the ACL is very effective and the risks of surgery are relatively low in part because it is most often performed arthroscopically and also because Dr. Manning is an expert in ACL reconstruction.

To learn more, please contact our office to schedule a consultation with Dr. Manning. During the consultation you will have the opportunity to decide if an ACL surgical reconstruction is appropriate or if nonsurgical treatment can be pursued.