Non- Operative Treatment of an ACL Injury
Updated: Oct 16
We’ve talked about the signs, and symptoms of an ACL rupture before
We talked about the protocol’s post an ACL surgery
But what you might not have heard of is that it is actually possible to come back to sport without ACL surgery. There are numerous examples in professional sport of athletes at the elite level coming back from such an injury.
“But how does ACL non- operative treatment work?”
It is a pretty common question that we get asked. The short answer is, by strengthening your quads, glutes, hamstring and calf muscle you can compensate for not having an ACL well enough to keep your knee stable during pivoting sports.
It might sound strange, but to see how this works, you need to understand what the ACL’s role is.
The ACL works to:
1. stop your tibia (your shin bone) sliding forward
2. Stabilise your knee when you pivot.
3. It is most taut when your knee is fully straight.
Now with number one, the tibia commonly moves forward during deceleration (i.e. when trying to slow down, which is a component in change of direction). The hamstring muscle group actually play a similar role. Strong hamstrings will help pull your tibia back.
With number 2, good quad strength can help stabilise your knee. The other part is training up your proprioception (your bodies awareness in space) so that your technique will change direction is safe and effective. ACL injuries commonly occur during change of direction when the knee is straighter, and away from your body. But by training your body to change direction with a knee that is more flexed and closer to underneath your body you can reduce the risk of injury.
What does the research say?
So that’s the theory behind it. Now onto the research.
The research shows us three things.
You can successfully return from an ACL rupture without surgery
There is a lot of research to show that you can return from an ACL injury. In 2013, 121 young adults were followed after an ACL injury, to see how they progressed with or without surgery. 30 of those adults did not have or need surgery 5 years later. They had similar scores in function, and arthritic changes.
An ACL reconstruction is no guarantee of returning to pivoting and contact sport
A study in 2014 showed that only 63% of non- elite athletes returned to the same level of competition they were doing before their injury. In professional athletes it is 83%. The same study we mentioned early in 2013, had only 20% of participants playing the same level of sport 5 years later (regardless of treatment choice)
Having or not having an ACL reconstruction will change your risk of osteoarthritis
A study done in 2019 showed that regardless of what option you choose, your risk of osteoarthritis will not change. Rupturing your ACL will increase your risk of an ACL rupture by 4- 6 times. Surgery will not change it.
Is non- operative ACL treatment right for you?
There are a number of factors to consider regarding non- operative ACL treatment. Some of them include:
Your goals (i.e. what sport you want to get back into)
What level of sport you want to get back into
Whether your knee is stable or unstable (i.e. episodes of giving way)
Other injuries you may have sustained when you ruptured your ACL (meniscus, MCL, PCL)
Your previous history with injury
How committed you will be to your rehab (ACL rehab post surgery will be a minimum 9- 12 months)
Financial costs (surgery on average costs around $9,000, and the post operative rehab over the 9- 12 months will be around the same).
So all this might sound great. So why do so many surgeons tell you that you need surgery for your ACL?
It's a really good question.
"If all you have is a hammer, everything looks like a nail". Surgeon's are really good at a number of things, but the best thing they do is operate. They see a problem, they want to fix it. What they might not always understand is how effective strength training can be, and the bodies ability to heal and respond to exercise.
Lastly, (and this is the unfortunate reality of private healthcare) ACL injuries are big business. In Australia from 2014- 2015, the hospital costs of ACL surgery was $142 million dollars, with the average hospital cost being nearly $9,000. That figure doesn't even include the rehab afterwards, which is would be around the same cost (our rehab program is nearly half that). The reality is, there will always be this conflict of interest, and more often than not money will win.
That's not to say that you shouldn't listen to your specialist or surgeon. We will always work with and recommend the best surgeon's and specialist to deliver the best possible outcome for you.
Want to learn more about ACL injuries? Check out our new ACL specific website here