Torn ACL – Rehab vs. Surgery
The knee is one of the most important joints in the body, and it’s also a very complex mechanism that relies on several ligaments and bone structures to operate properly. There are four tendons within the knee joint and the ACL. The ligament responsible for stabilizing the knee, runs diagonally in the center of the knee and works to prevent the tibia from sliding out in front of the femur, as noted by the American Academy of Orthopaedic Surgeons. The ACL is one of the most frequently injured ligaments in the knee, with an estimated 200,000 injuries per year.
Causes of Torn ACL Tendons
ACL tendons can be injured in a number of ways. Sports injuries are the most common, but the ligament can also be torn in non-sports related activities. The most common form of injury involves rapid deceleration combined with sharp movement (the AAOS cites cutting, pivoting and sidestepping motions, as well as awkward landings).
Immediately after tearing the ACL, the person will experience serious swelling and pain, as well as a feeling of instability within the knee. Within only a few hours, the knee is typically immobile, and patients experience discomfort while walking as well as pain along the knee joint.
There are two forms of treatment available for a torn ACL – surgical intervention and nonsurgical treatment, or rehab. Both have their own pros and cons, and you should follow your orthopedic doctor’s advice concerning which is right for you. However, it’s important to understand exactly what each form of treatment offers.
Nonsurgical Treatment (Rehab) – The preferred form of treatment for a torn ACL is nonsurgical rehabilitation. This combines rehabilitation with “progressive” physical therapy. Over time, this can provide almost the same amount of flexibility, stability and strength as the patient experienced before the injury occurred. However, full recovery is often not possible. The patient will also be educated regarding injury prevention. Rehab and physical therapy tend to be the better choices for patients whose growth plates haven’t closed yet, who don’t generally exert themselves strenuously, who have complete ACL tears but no knee instability in low-demand sports, and those with partial tears and no instability.
Additionally, new studies conducted by the Mayo Clinic seem to indicate that rehabilitation is a better choice for most patients with a torn ACL, even if they intend to return to high-intensity sports.
Surgical Treatment – Surgical treatment for a torn ACL usually involves replacing the torn ligament with a tendon graft. Repairing a torn ACL with sutures was once common, but these repairs tend to fail over time, making a tendon graft the better option. Statistically, surgical success ranges from 82-95% of patients, with an overall instability recurrence rate of about 8%.
However, even in situations where surgery is performed, rehabilitation and physical therapy will be necessary after the procedure to ensure the best range of motion and proper healing within the knee and the replacement ACL.
Which Treatment Is Right for You?
The vast majority of patients with partial tears of the ACL (and no instability) will undergo rehabilitation and physical therapy, usually with the addition of a knee brace. Patients with complete tears and partial tears coupled with instability episodes will likely be recommended for surgical treatment, followed by physical therapy and rehabilitation.
However, a growing number of physicians recommend beginning with rehabilitation before opting for surgical intervention, particularly for patients who are not involved in high-level professional sports. After rehabilitation and physical therapy, a patient experiencing repeated instances of instability would be recommended for surgery. There is no one-size-fits-all solution here, and patients should discuss their options with their orthopedic surgeon.
Surgeon’s Advice | Leon Mead MD Orthopedic Doctor | 730 Goodlette Road North, Suite 201 Naples Florida 34102 | Phone: (239) 262-1119