A torn cruciate ligament may not mean immediate reconstruction
By Julia Newton, physiotherapist
We've all seen it on television and cringed. The footballer stepping to pass a defender, his body weight going one way and his knee the other. This is followed by the big man collapsing on a knee buckling inward. Ooooh! The commentators lament on a possible anterior cruciate ligament (ACL) tear with a passing mention of year off to rehabilitate. Australia has the highest reported rate of ACL reconstructions in the world, costing an estimated $142 million per year for hospital systems.
For those that aren't familiar with ACL, it is a ligament that runs from the femur (thigh) to the tibia (shin) and its purpose is to limit excessive forward translation or slipping of the knee joint. Without this important ligament, the knee can feel unstable and weak.
Despite it being such an important ligament, it is actually possible to function with a complete ACL tear and therefore may not actually always be mandatory to get an ACL reconstruction ASAP.
A recent and very interesting study compared 3 groups of participants with a complete ACL tear. The first group had an immediate ACL reconstruction combined with exercise therapy. The second group had a delayed ACL reconstruction (which allowed extra time for strengthening exercises in preparation of surgery). The third group received exercise therapy treatment alone, with no reconstruction surgery. Surprisingly, there were poorer outcomes from some participants in the first group that had immediate ACL reconstruction. In this group, they found that those with a higher impairment in the knee, with additional cartilage damage did poorer post operatively and would have benefited more from having a delayed reconstruction and some exercise therapy beforehand in preparation.
This study highlighted the fact that every person is different, and in order to make an informed decision about management options, there needs to be a discussion tailored to the individual's sporting, personal and injury-related characteristics.
The main take home point from this is to not rush into a decision on your management straight away, and get an opinion from more than one practitioner if you feel you need to.