Is Surgery Needed For ACL Tears?
An ACL injury is the most common and most feared knee injury. A twist of the knee, a sudden popping sound, and the joint no longer works. More than 150,000 ACL ruptures happen yearly, with many needing minimally invasive surgery. But is surgery always the answer? Can the ligament heal and function naturally?
Let’s dig a little deeper
The anterior cruciate ligament is a small but vital ligament located in the knee. The ligament makes a cross shape with the posterior cruciate ligament (PCL), connecting the thigh bone and shin bone. This connection stabilizes the knee and is critical for twisting and turning motions. Athletes in sports like football, soccer, and basketball depend on the ACL for explosive movement. A blow to the knee, sudden change of direction, or an awkward landing can tear the ligament.
Why tears need surgery
The ACL is a durable piece of tissue. However, there is no real blood supply, which implies that self-healing is near impossible. That’s why almost all ACL tears undergo surgery to replace the tendon. Surgery becomes all the more important for athletes who want to get back to action as soon as possible. However, not all ACL tears need surgery. There are, in fact, 3 grades of ACL injuries, 2 of which are tears.
Partial tears and rehabilitation
Doctors categorize ACL tears into 3 grades. A grade 1 injury is considered a sprain. The ligament becomes stretched, losing elasticity. Grade 2 injuries are partial tears. Part of the ACL is still attached but torn and damaged. Grade 3 tears are full tears and are unable to support the knee. Grade 1 and 2 injuries respond well to bracing and physical therapy. A study revealed that persons who opted against surgery had similar results to those with surgery. Rehab works, but there are other factors at play.
Factors affecting surgery
There is some evidence that ACL injuries do not always require surgery. However, taking a non-surgical approach may not be best. Active persons may not benefit from a non-surgical treatment plan. The length of healing can keep athletes out of sports longer than expected. Non-surgical recovery means that the knee depends on other ligaments. This dependency can cause damage to areas like the meniscus. Also, an ACL that heals without surgery may not be as stable. For a fully functioning knee, minimally invasive surgery may be best.
Small incisions, significant results
To repair with surgery, surgeons opt for an ACL reconstruction. Using two or more small incisions, the surgeon inserts an arthroscope and small tools. The surgeon then cleans and removes the damaged tissue. Next, the surgeon inserts a replacement tissue either via a donor or another part of the body. Finally, the button-hole incisions are closed, and the patient is sent to recovery. From there, the patient goes through rehabilitation to restore strength and range of motion. Full recovery can take anywhere from 6-12 months.
Take the next step
Based on the degree of injury, patients can decide on the course of action. Minor tears can respond to non-surgical therapy. Full tears, however, need ACL reconstruction, especially if the goal is to return to activity soon. ACL reconstruction is minimally invasive, with a high success rate. Speak with a doctor about what’s best based on injury, goals, and personal preferences.