Does an ACL Rupture Need Surgery?

I just had a long chat with an adult soccer player who recently ruptured his ACL and discussed some of the newer revelations that have been coming out of the orthopedic and rehab world regarding optimal management for ACL tears. It’s been really interesting following this conversation in the research for awhile and working the latest evidence into my practice.

We live in a fast paced world, where often times we can rush into decisions to fix problems before we’ve had a chance to learn more about how they might respond over a longer period of time without aggressive action (like surgery). Often, by giving ourselves more time in these non-emergent situations, we may learn whether we fit into the different categories that may warrant surgery, or that could spare us the surgical intervention.

We are learning more about instances where ACLs spontaneously heal at larger numbers than most providers would have previously thought. We are also seeing cases of patients who can return to their full activities without surgical repair post rupture given the stability of the other surrounding structures of the knee. There are certainly pros and cons to making the decision to go forward with a surgery or not, but if it’s possible to avoid the secondary trauma of surgery and the corresponding healing times related to this (as well as the significant cost implications) it warrants a closer consideration of the options you have, and should at least be a point of discussion with the orthopedist you may be working with.

Remember, there is never just one solution to a problem, so keep your mind open and keep asking questions.

Want to learn more? Check out some recent research and resources below:

Adam Meakins (@thesportsphysio) just shared two helpful posts on this topic and for anyone interested in learning a little more about how to make this decision for yourself or a loved one, it was certainly interesting to dive into some of the supporting research he shared as well as hearing the anecdotal evidence in the comments section.

https://www.instagram.com/p/Cj0rLfSspFU/?igshid=MDJmNzVkMjY=

https://www.instagram.com/p/CjxXV86MhE7/?igshid=YmMyMTA2M2Y=

Mick Hughes who has masterclasses in ACL rehab also discusses this in his blog.

https://www.mickhughes.physio/single-post/can-the-acl-spontaneously-heal-after-rupture

This article on Physio Network covers the topic pretty thoroughly as well

This is a cool one too - a case study on an English Premier League player returning to play 8 weeks post-rupture without surgery:

https://pubmed.ncbi.nlm.nih.gov/25917066/

Another podcast that covers this topic is the Young Athlete Podcast: Episode 12 - Non Surgical Management of ACL Injuries - Kieran Richardson

There are always a lot of factors and considerations that go into making this type of decision, so if you’d like to discuss your specific case be sure to reach out via email or schedule a discovery call.