Is it advisable to rehab your torn ACL without surgery?
If you’re willing to avoid high-impact activity and have no or minor other injuries in your knee, you can consider foregoing surgery. Some people live comfortably with the “no-op” choice.
Two things to know:
Without surgery, after rehabilitation, you should be able to:
Some people decide against surgery and successfully return to activities or sports that normally do not involve twisting the knee. You may be able to resume alpine skiing, for instance, even if a fall on the slopes was how you tore your ACL.
While you might be able to enjoy these activities, performance might be below your preinjury experience. (Even with reconstruction surgery and complete rehabilitation, most people report achieving something less than their full preinjury sports capability.)
In addition to the five main ACL surgery decision factors, there are two others to consider when deciding whether to have ACLR surgery:
Without surgery, your ACL will remain torn. The knee might heal—the swelling and pain will stop. But a torn anterior cruciate ligament does not reattach or heal itself.
You may still be able to live how you want by strengthening your leg and core (your hips contribute to leg strength and function) and adjusting your activities. If your desired activities require maintaining strength to avoid injury, you will need to continue training as long as you participate.
Possible long-term downsides of not having ACL surgery:
The recommendations immediately following an ACL injury are similar whether or not you plan to have surgery:
An ACL injury is traumatic. It causes acute weakness in your leg, swelling, bleeding into the joint (hemarthrosis), loss of motion and reflex inhibition in your quad muscle.
Following your injury, there will be immediate swelling. You may be unable to straighten your leg. Your knee may be unstable. A weak leg without an ACL can allow the knee to move in unintended ways. This can injure other parts of your knee.
With or without surgery, rehabilitation is critical to recovering leg strength and functional control. You’ll benefit from at least a basic rehabilitation program and then keeping your leg and core strong. The more active you want to be, the more you’ll want to restore strength and control in your leg.
Another rehabilitation benefit? Regular evaluation by a professional familiar with ACL injuries. Physical therapists and athletic trainers can identify and remedy weaknesses to keep your program on track. They can also advise and encourage you when you are ready to return to activities.
You might be able to return to activities others cannot. And what others can do—especially someone reporting a miraculous return to sport or work—might not be possible for you.
Read the studies about non-surgical outcomes carefully. Look for data on what activities those not having surgery can perform and at what level. Also note how long after injury someone is reporting on their return to activity and their level of performance. A report at six months is less informative than at two or six years.
Younger patients especially will want to discuss with their doctor the impact of living without a functioning ACL.
The recommendation? Discuss your objectives with your surgeon and physical therapist or athletic trainer, then make the choice that you believe works best for you.
There are five primary factors in the decision to have ACL reconstruction surgery. Discuss them with your surgeon and physical therapy and athletic training professionals, family and other advisors.
If you’ve also injured other ligaments (especially your medial collateral ligament), your meniscus or articular cartilage (the soft and slippery substance covering the ends of the thigh and shin bones in the knee), surgical reconstruction is recommended.
Without a functioning ACL, it will be difficult to return effectively to sports, work or other activities with aggressive jumping, cutting and pivoting. The more competitive the sport, the more it stresses the knee and the higher performance you want, the lower the probability you can return without ACL reconstruction. Most people who try to rehab without surgery do not return to sport.
Your sport, position and the level of competition—or the kind of work you do—create specific and different stresses on your knee. Skiing is different from soccer. Running back is different from defensive lineman. High school is different than college Division 1. This is why you want to discuss your situation with your medical professionals.
Not having surgery skips recovery from the operation. It usually lessens the rehabilitation time you need to return to normal activities. But if you want to return to play or aggressive jumping, cutting and pivoting, your “no-op” rehab program will be similar to the post-surgery regimen. And, as noted above, without surgery, the odds are against a successful return to any sport with aggressive movement.
It can take months of rehab to find out if you can achieve the strength and functionality you want without surgery. If not, you’ve added those months to the typical nine-month (or more) return-to-sport program after ACL reconstruction surgery. Rather than risk missing a second season, athletes frequently elect surgery as soon as recommended after their injury.