Torn ACL may not always mean surgery
July 22nd, 2010
03:53 PM ET

Torn ACL may not always mean surgery

Tearing an ACL doesn't always mean a trip to the operating room, especially if you're young and active, researchers  report in the New England Journal of Medicine.

The knee's ACL, or anterior cruciate ligament, acts like a rubber band that connects your thigh bone to your leg bone. It provides stability to the knee especially when playing sports such as soccer, basketball or tennis that call for stopping, planting and pivoting. When it pops or tears it requires a trip to your doctor.

Researchers at Lund University in Lund, Sweden wanted to find out whether recovery and use of the knee were more successful depending on when or whether you had surgery.

The experts asked 120 young, active adults who had torn an ACL to undergo one of two different treatments. The first group had surgery shortly after the injury while the other patients received rehabilitation with the option of later ACL surgery if needed. Physical therapists supervised rehabilitation sessions for the second group and often advised patients to use a knee brace when playing sports.

At the end of two years less than half those in the rehab group had opted for ACL knee surgery. And when patients were asked about how satisfied they were with their knee – measured by function, pain levels, and the ability to return to pre-injury activities – the answers were about the same between patients who had gotten surgery shortly after injury and those who had not.

But delaying surgery is not without risks. Elite athletes who plan to continue playing sports requiring quick changes in direction and lots of twisting need a healthy ACL and are usually advised to undergo surgery soon after their injury. Also, the likelihood of developing arthritis increases if an unstable knee gives way leading to a fall. A torn ACL may mean more wear and tear on other knee structures which may mean a trip to your surgeon for a different type of knee operation.

Orthopedic Surgeon Bruce Levy with the Mayo Clinic in Rochester, Minnesota, says no one treatment strategy is right for all patients.

"It's important that every patient discuss the pros and cons of surgical management and non surgical management with their doctor and that a treatment strategy be individually tailored to the specific knee injury and the specific knee of the patient," says Levy.

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