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ACL Injury: Surgical vs. Non-Surgical Treatment

You’re about to score another footie goal, perform an impressive slam dunk or pull off the perfect ski slalom. Then it all goes wrong. There’s a popping noise and your knee gives way. The pain is intense and the knee is swelling fast.

Why? Because you’ve injured your ACL. You’re going to be benched for a while as you undergo diagnostic tests, physiotherapy and possibly surgery followed by more physiotherapy.

What is an ACL injury?

Your anterior cruciate ligament (ACL) is one of two major ligaments in your knee. It’s a strong band of tissue that connects your femur (thighbone) to your tibia (shinbone) to help stabilise your knee joint.

An ACL injury happens when you tear or sprain that ligament.

How do ACL injuries happen?

As noted above, your ACL’s job is to stabilise your knee during movement. So, it’s not surprising that most ACL injuries happen during sports or fitness activities that involve movements such as:

Sudden stops
Sudden changes of direction
Jumping and landing
Collisions and tackles.

These are common movements in sports like soccer, AFL, basketball or skiing.

Then there’s your own physiology. Female athletes seem to be at higher risk of ACL injuries, possibly due to factors like the shape of the female pelvis and lower leg alignment, the effects of estrogen on ligaments and differences in conditioning, strength and neuromuscular control.

When an ACL injury happens you may:

Hear or feel a ‘pop’ in your knee
Experience severe pain
Be unable to continue what you were doing
Notice rapid swelling around your knee
No longer have the full range of motion in your knee
Feel unstable when you put weight on your knee, with a sense that it’s about to give way.

Diagnosing an ACL injury

You need immediate medical attention for an ACL injury to rule out any other conditions, provide initial treatment and, eventually, decide on a long-term treatment and rehabilitation plan.

Your doctor will examine you, discuss what caused the injury and possibly order an X-ray to see if you’ve broken any bones and an MRI to examine your soft tissues. Around 50% of ACL injuries also involve damage to other parts of your knee like your cartilage, meniscus or other ligaments, so it’s important to know exactly what’s going on.

Types of ACL injuries include a mild sprain (grade 1), a partial tear (grade 2) or a complete tear (grad 3).

Treating an ACL injury

Treatment for an ACL injury involves physiotherapy and, in some cases, surgery to reconstruct the knee.

Non-surgical treatment for an ACL injury

ACL treatment through physiotherapy helps you regain knee movement, reduce swelling, strengthen supporting muscles and regain your normal walking pattern.

Your physiotherapy program is likely to focus on:

Regaining your muscle strength, particularly in your quadriceps, hamstrings and hip muscles
Normalising your movement patterns of hopping, running, jumping, landing and turning to reduce the risk of reinjuring your knee.

Your physio will think about how your knee needs to function to enable you to live the life you want, such as achieving your sporting goals or fulfilling your job requirements.

Depending on how you look at it, physiotherapy is either rehabilitation after injuring your knee (i.e. all the treatment you need for your level of injury and preferred lifestyle) or prehabilitation for surgery (i.e. a way of strengthening your knee prior to surgery to improve outcomes).

For mild to moderate ACL injuries, physiotherapy may enable you to regain the stability you need without the risks of surgery. ACL recovery time without surgery may be around 3 months, depending on your situation.

After 2-3 months of physiotherapy, it should be clear whether conservative management is working or whether surgery may be needed.

Surgery for an ACL injury

If you have completely torn your ACL, it will need reconstructive surgery since it cannot heal by itself. ACL reconstruction involves rebuilding the damaged ligament with part of your hamstring or knee cap tendon.

Physiotherapy before surgery helps you get into the best possible shape before the op. After surgery, you’ll enter a rehabilitation program, using physiotherapy to strengthen the surrounding muscles to help stabilise your knee.

How do you decide whether or not to have surgery for an ACL injury?

It’s not always easy to decide on the right way forward. You want a strong and stable knee but you don’t necessarily want large medical bills and time off work.

When considering surgery, you need to take into account:

The demands you’re likely to place on your knee – do you still plan to play agility sports, for example?
How damaged and unstable your knee is now – a full ACL tear with damage to surrounding tissue may require surgery whereas a lesser injury makes non-surgical options more attractive
Your personal situation – do you have health insurance and sick leave?

You’ll no doubt have received a recommendation already from your GP, physio or surgeon. But this is a big decision. It’s always wise to ask for a second opinion from another healthcare professional who will meet with you, review your situation and provide their advice. If both healthcare professionals agree, you’ll feel more confident that this is the right way forward. If they disagree, it means you have more than one viable treatment option and can weigh up the pros and cons of each choice.

How The Brisbane Spine Clinic can help

As you can see, physiotherapy plays a key role in treating an ACL injury. It may be all the treatment you need or it may be a pre- and post-surgery program.

Either way, you need a capable physiotherapist whose skills and opinion you trust. You need The Brisbane Spine Clinic.

We’re here to support you at each stage of your recovery from an ACL injury. With an interest in sports physiotherapy, we’re keen to help you get back to your athletic lifestyle.

After careful examination, we’ll develop a tailored program of exercises to strengthen your knee. We can provide a second opinion to help you judge whether or not to have surgery. And we can support you before and after surgery as you learn to trust your knee again.

Please contact us today. We’d love to help you get moving again.