The anterior cruciate ligament (ACL) is a crucial ligament within the knee. It runs from the thigh bone (femur) to the shin bone (tibia) and helps stabilise the knee joint.
Injuries to the ACLoften called a “tear” or a “rupture”, are common in sport. While a ruptured ACL has just sidelined one other Matilda’s starindividuals who play sport recreationally are also susceptible to this injury.
For many years, surgical repair of an ACL injury, called a reconstruction, has been the first treatment in Australia. In fact, Australia has among the many highest rates of ACL surgery on the planet. Reports indicate 90% of individuals who rupture their ACL go under the knife.
Although surgery is common – around a million are performed worldwide every year – and appears to be the default treatment for ACL injuries in Australia, it might not be required for everybody.
What does the research say?
We know ACL ruptures might be treated using reconstructive surgerybut research continues to suggest they will also be treated with rehabilitation alone for many individuals.
Almost 15 years ago a randomised clinical trial published within the New England Journal of Medicine compared early surgery to rehabilitation with the choice of delayed surgery in young lively adults with an ACL injury. Over half of individuals within the rehabilitation group didn’t find yourself having surgery. After five years, knee function didn’t differ between treatment groups.
The findings of this initial trial have been supported by more research since. A review of three trials published in 2022 found delaying surgery and trialling rehabilitation results in similar outcomes to early surgery.
A 2023 study followed up patients who received rehabilitation without surgery. It showed one in three had evidence of ACL healing on an MRI after two years. There was also evidence of improved knee-related quality of life in those with signs of ACL healing in comparison with those whose ACL didn’t show signs of healing.
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Regardless of treatment alternative the rehabilitation process following ACL rupture is lengthy. It normally involves a minimum of nine months of progressive rehabilitation performed just a few days per week. The length of time for rehabilitation could also be barely shorter in those not undergoing surgery, but more research is required on this area.
Rehabilitation starts with a physiotherapist overseeing easy exercises throughout to resistance exercises and dynamic movements corresponding to jumping, hopping and agility drills.
An individual can start rehabilitation with the choice of getting surgery later if the knee stays unstable. A typical sign of instability is the knee giving way when changing direction while running or playing sports.
To rehab and wait, or to go straight under the knife?
There are a lot of reasons patients and clinicians may go for early surgical reconstruction.
For elite athletes, a key consideration is returning to sport as soon as possible. As surgery is a well established method, athletes (corresponding to Matilda Sam Kerr) often go for early surgical reconstruction as this provides them a more predictable timeline for recovery.
At the identical time, there are risks to think about when rushing back to sport after ACL reconstruction. Re-injury of the ACL may be very common. For every month return to sport is delayed until nine months after ACL reconstruction, the speed of knee re-injury is reduced by 51%.
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Historically, one more reason for having early surgical reconstruction was to scale back the chance of future knee osteoarthritis, which increases following an ACL injury. But a review showed ACL reconstruction doesn’t reduce the chance of knee osteoarthritis in the long run compared with non-surgical treatment.
That said, there’s a necessity for more high-quality, long-term studies to provide us a greater understanding of how knee osteoarthritis risk is influenced by different treatments.
Rehab might not be the one non-surgical option
Last yr, a study taking a look at 80 people fitted with a specialised knee brace for 12 weeks found 90% had evidence of ACL healing on their follow-up MRI.
People with more ACL healing on the three-month MRI reported higher outcomes at 12 months, including higher rates of returning to their pre-injury level of sport and higher knee function. Although promising, we now need comparative research to judge whether this method can achieve similar results to surgery.
What to do for those who rupture your ACL
First, it’s necessary to hunt a comprehensive medical assessment from either a sports physiotherapist, sports physician or orthopaedic surgeon. ACL injuries also can have associated injuries to surrounding ligaments and cartilage which can influence treatment decisions.
In terms of treatment, talk to your clinician the professionals and cons of management options and whether surgery is needed. Often, patients don’t know not having surgery is an option.
Surgery appears to be needed for some people to realize a stable knee. But it might not be needed in every case, so many patients might need to try rehabilitation in the primary instance where appropriate.
As at all times, prevention is essential. Research has shown greater than half of ACL injuries might be prevented by incorporating prevention strategies. This involves performing specific exercises to strengthen muscles within the legs, and improve movement control and landing technique.