An ACL tear is one of the most feared knee injuries in sports. For many years, patients were told that if the ACL was completely torn, surgery was the only option.
Recent research shows that this may not always be true.
The decision is no longer automatic. It depends on your knee stability, activity level, and goals.
In this blog we will go over some of the recent research. Please read thoroughly so you can make an informed decision about your knee!
Different Types of ACL Tears
Grade 1 ACL Tear
A small portion of the ligament is torn
- Treatment is physiotherapy
Surgery is not required
Grade 2 ACL Tear
Half of the ligament fibers are torn
- Treatment is physiotherapy
Surgery is usually not required
High-Grade Partial Tear
Most of the ligament is torn, but some fibers remain
Treatment begins with physiotherapy
If the knee feels stable and strong, surgery may not be necessary
If the knee continues to give way during sports, surgery may be recommended
Grade 3 ACL Tear (Complete Tear)
The ligament is fully torn
In the past, surgery was considered necessary for everyone
New research suggests that some people can recover well with physiotherapy and other types of conservative management.
What Does the Research Say?
A large study published in the British Journal of Sports Medicine looked at people with complete ACL tears. This study is known as the KANON trial.
Researchers followed 120 young, active adults and compared two groups:
Surgery first, followed by physiotherapy
Physiotherapy first, with surgery only if needed
They used MRI scans and patient feedback to track healing and function over time.
What They Found
About 30 percent of people showed signs that their ACL had healed on MRI after two years.
Patients stuck with physiotherapy and did not have surgery, about 50 percent showed healing.
Healing could sometimes be seen as early as three months.
In some individuals, the ACL may have the ability to heal with structured rehabilitation.
Does This Mean No One Needs Surgery?
No. Some things to consider are:
Professional athletes were not included in the study
If the knee is unstable, high-level athletes who play cutting and pivoting sports may still benefit from surgery
Some knees may feel loose even if the person feels good
Other studies show younger patients, and younger female patients who don’t do pivoting sports may not benefit from a surgery.
- There are other risks of surgery depending on your medical condition.
The research shows that surgery is not always required, but it does not mean surgery is never needed. Usually the deciding factor is, is your knee unstable, is it positive on physical exam, and what is your activity level?
In Summary:
Once again, every patient is unique, so please talk to your physiotherapist and your surgeon about what makes the most sense for YOU.
In our healthcare system, most patients will end up seeing a physiotherapist first before they see a surgeon. So the first step is usually a thorough assessment and a clear rehabilitation plan.
From there, the decision about surgery can be made based on how your knee performs, not just what the MRI says.
If you need further guidance of have any questions, please contact our clinic for a consult! We are passionate passionate about patients undertaking physiotherapy rehabilitation to solve their pain and injury problems, prior to opting for surgery.
