ACL RECONSTRUCTION – IS IT ALWAYS NECESSARY?

ACL RECONSTRUCTION – IS IT ALWAYS NECESSARY?

ACL ruptures are commonly sent straight for surgical repair, however this requirement has recently been questioned more and more. Evidence now tells us that conservative rehabilitation following ACL rupture has similar outcomes to surgery (Smith et al., 2014 & Forbell et al., 2010). The risk of developing osteoarthritis also appears to be similar for both surgical and conservative management (Oiestad et al., 2009).

So if that is the case – should we all be trialling conservative rehab and avoiding surgery?

Dynamic demands on the knee and thus risk of re-injury are higher in multi directional field sports such as football and soccer (Weinhandl et al., 2013). Also, stress on the medial meniscus is doubled after ACL rupture without surgery (Jones et al., 2003), which increases the risk of complications when returning to high-risk sports.

Therefore, individual circumstances need to be considered when deciding on the appropriate management of an ACL injury. Surgical opinion should be sought when wanting to return to pivoting sports. However conservative rehabilitation may be appropriate for those only wishing to return to more forgiving sports (such as cycling, golf or running).

Chris Bryceson

B. Health Sciences (Physio), APAM

CB Physiotherapy