An ACL injury is common in competitive sports such as football, rugby, and basketball. While people may assume that ACL injuries happen more in contact or traumatic events during a game or training, research shows that noncontact injury mechanisms are more prevalent in competitive sports. In addition, women generally have a higher risk of an ACL tear than men due to different biomechanics, such as ligament laxity and a larger quadriceps angle.
When this unfortunate event happens, there are two treatment methods to consider:  conservative and surgical.

Conservative Management 

Pros and Cons of Conservative Management 

Surgical Approach

The two most used tendon graft sites:

There is very little to no difference between the first two options regarding their effectiveness. Both have been shown to provide good subjective outcomes and objective stability. Allografts have been observed with significantly higher failure rates.

Recovery Timeline – after ACL Reconstructive Surgery

Eligibility for Management Options

If both options are available to people who suffer from an ACL tear, what is the indication to pursue a surgical or a conservative approach?
There are 6 criteria that determine the best course of action for the individual suffering the injury. These criteria will be established during the initial consultation, upon which a suitable injury management plan will be created.

The anterior cruciate ligament stops the anterior tibial translation and limits rotational knee movements. There are three grades of ligamentous injuries, from grade 1 to 3. Surgical treatment is recommended for those with a complete (grade 3) ACL tear. You may not need surgery for a partial tear (grade 2) of the ACL or a strained ligament (grade 1).

When patients experience repetitive knee buckling and instability, despite undergoing proper conservative rehabilitation, reconstructive surgery is recommended. Patients can assess their instability during twisting and pivoting movements and provide a subjective rating of knee instability, or schedule an appointment with one of our therapists to perform a ligament laxity test. The results of the test will help determine whether surgery is necessary or not.

Usually, patients who experience an ACL injury along with either a high-grade meniscus tear or a medial collateral ligament (MCL) tear will need surgery to restore the stability of the knee. These structures are highly involved in knee stability, therefore reconstruction and repair of the damaged soft tissue will be necessary.

For those whose jobs do not involve heavy physical activity or live sedentary lifestyles, reconstructive surgery may not be necessary, provided that no or limited knee instability is observed. However, for those who engage in high-demand sports that involve jumping, cutting, and pivoting, it is essential to have stable knee joints to prevent any secondary injuries.

The reconstructive surgery is usually not recommended for those whose growth plates are still open. Growth plates usually close near the end of puberty. For females, around 13-15 years of age; for males, it is usually when they are 15-17 years of age. However, recent research shows that the traditional transtibial technique and a newer technique, called transphyseal ACL reconstruction, can both protect the opened growth plate as much as possible. It is best to discuss this with the surgeon upon making the decision.

Personal preference. Discussing the decision to undergo surgery can enhance patient satisfaction and outcomes. The desire to return to sports or activities, the potential risks and benefits of surgery, recovery time, and impact on daily life are perceived differently among individuals. Understanding personal preferences in the treatment approach can align with the goals and expectations of the patients.

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Who Can Consider this Treatment Approach? 

Who Can Consider this Treatment Approach? 


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