ACL Surgery or just Physio?

Imagine this scenario: a 30 year old basketball player comes to you with a confirmed ACL tear and asks you if he should consider surgery. What do you tell him?

One school of thought says that everyone should get ACL reconstruction surgery (especially if you live in the USA and have insurance). The other school of thought says wait and see if you can function without your ACL after 12 weeks of aggressive rehab.

Which is the better approach?

This study involved 120 young, active adults with acute ACL injury who were placed into one of two groups.

Group 1: PT plus early ACL reconstruction

Group 2: PT with the option of later ACL reconstruction if needed

All the patients were followed up for 2 years.

Of the patients in group 1, 98% received the ACL surgery which makes sense. However of those placed in group 2 only 40% opted for surgery within the 2 year period and 60% opted out of surgery as they felt they could function well despite their knee laxity.

There were no significant differences between the two treatment groups with respect to their pain, functional and quality of life scores.

Once again, a 30 year old basketball player comes to you with a confirmed ACL tear and asks you if he should consider surgery. What do you tell him?

Based on the evidence, tell him, “Let’s try 3 months of aggressive rehab and if you still feel like your knee is sore or loose, consider the surgery. After physio, there is a 60% chance that you may not even need the surgery!”

Reference: Frobell et al A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med. 2010 Jul 22;363(4):331-42.