Can You Treat An ACL Tear Without Surgery? Understanding Anterior Cruciate Ligament Reconstruction

What Is An ACL Tear?

The anterior cruciate ligament (ACL) is one of two stabilizing ligaments of the knee. The ACL prevents excessive forward movement of the tibia or shin bone and is one of the most commonly damaged structures related to sports injuries. The ACL is a strong band of connective tissue housed within the knee joint that attaches the femur or thigh bone to the tibia. Injury typically occurs in sports like basketball and soccer, where the foot is firmly planted, and a sudden directional change takes place during jumping or pivoting. Overstretching of the ACL can lead to a partial or incomplete tear or a complete rupture where the fibers are fully torn. Symptoms of a tear include a sudden onset of pain and swelling in the knee and instability with restricted knee movement.

ACL repair deconstructed

ACL reconstruction entails replacing the damaged or torn ligament with a graft during a minimally invasive surgical procedure known as arthroscopy. Through small incisions, a surgeon uses a tiny camera to look inside the knee while making repairs with precision instruments. A tissue graft is harvested from the tendons of the patella and hamstrings, or a cadaver donation is used to reconstruct the ACL. The new ACL is tunneled through the knee and secured on each end by bioabsorbable screws. Small adhesive strips or stitches are used to close the incisions, and a soft bandage knee wrap is placed.

Can you skip surgery?

Following an ACL injury, the ACL is weakened, and the knee is unable to be stabilized. Other structures in the knee are put under maximal stress, including the knee cartilage and menisci, potentially leading to osteoarthritis later in life. Chronic knee pain and instability can impact athletic activities and sideline participation. Prolonging ACL reconstruction can also lead to a sensation of the knee giving out and increase the likelihood of future injury to other structures and the opposite knee. Damage caused by an untreated ACL could eventually lead to worse outcomes and more complex surgery or even the need for a total knee replacement.

Beyond the operating room

A fully torn ACL injury requires surgical intervention and reconstruction to reestablish the integrity of the knee structures. Treatment modalities are individualized and depend mainly on age, fitness level, lifestyle, and the type of tear. Research has shown that a partially torn ACL can heal over time with proper bracing and physical therapy, however, long term studies still need to be conducted. Further treatment includes aggressive physical therapy to strengthen the surrounding muscles and tissues and protect the knee with a hinged knee brace during higher-intensity activities.

Getting to full recovery

An ACL tear can cause a great deal of morbidity, and the best treatment options should be discussed with an orthopedic care team. Many factors are considered when evaluating treatment options for an ACL tear, including age, fitness level, lifestyle, and type of tear. Minimally invasive surgical procedures are available for complete ACL ruptures, which lead to faster recovery times and a return to physical activity. Untreated ACL tears can further injure other vital knee structures, predisposing the knee to cartilage damage and osteoarthritis. In some cases, physical therapy and hinged knee bracing can be utilized to treat partial ACL tears. Having a thorough evaluation by an orthopedic specialist can assist in making the best decision to get back to a game-ready condition.