Is there any alternative for an ACL injury other than surgery?

by Sudarsan

ACL injuries can cause pain in and around the knee joint, along with other symptoms such as swelling, stiffness, inflammation, and varying levels of immobility. Not all ACL knee injuries need surgery. Surgery is indicated if the knee is unstable, gives a buckling sensation, or has extreme pain. Surgery is strongly suggested by orthopedic doctors for patients who wish to return to a high level of activity, such as participation in pivoting sports, activities such as trekking, hiking, or other high-intensity sports.  

Treatment for an ACL tear will depend on the extent of the injury and the individual’s specific needs and goals. Many patients get relief with nonsurgical treatment options including the RICE technique, wearing a knee brace and physiotherapy. Non-operative treatment may be appropriate for patients who are not involved in regular physical and sport activity and have a relatively sedentary lifestyle. Individuals who do not participate in extensive recreational activities that require pivoting stability can choose nonsurgical treatments after an ACL injury.

Some individuals can continue with a normal lifestyle with an ACL injury but are likely to later suffer from other associated knee injuries or complications. For an individual with a physically active lifestyle, an ACL reconstruction surgery and physiotherapy is mostly the best answer for resuming an active lifestyle and athletics as quickly as possible. 

In all cases, it is important to see an orthopedic doctor immediately after an ACL injury to diagnose the grade of the ACL injury. The orthopedic doctor will also ensure that there is no damage to other ligaments or bones.  

Non-surgical treatment for ACL injury 

Immediately after your ACL  injury, you should follow the RICE method-

  • Rest– Activities which may cause knee pain, including running or walking for long periods, should be avoided until inflammation and associated symptoms are relieved.
  • Ice– The patient might be advised to apply ice packs to the knee joint to reduce pain and swelling. Ice packs can be very effective in providing instant relief from the pain and can be used several times throughout the day for about 10 – 20 minutes at a time.
  • Compression– The patient might be recommended to wear a tight, elastic bandage around the affected knee joint to reduce inflammation and swelling.
  • Elevation– The patient will be advised to elevate the knee and keep the knee supported above the waist level to help reduce swelling.

Non-surgical treatment for ACL injuries includes initial bracing for 1 to 2 weeks along with  RICE (rest, ice, compression, and elevation) and prescribed anti-inflammatory medications. A structured physiotherapy program will be recommended in order to reduce inflammation and restore the knee’s highest range of strength and motion. The orthopedic doctor will suggest some specific exercises to restore function to the knee and strengthen the muscles that support it. 

Patients should still keep their expectations realistic and realize that a torn ACL will not heal without surgery. But nonsurgical treatment can be effective for patients who are old in age or have a very low activity level with a Grade 1 ACL tear. If the individual’s stability of the knee is unharmed, the orthopedic doctor may recommend simple, nonsurgical treatment options.

If you want to return to a physically active lifestyle, you should consider ACL Reconstruction Surgery

ACL reconstruction is recommended for most patients who wish to return to their physically active lifestyle including sports and extensive activities such as hiking, trekking, etc. Patients diagnosed with a torn ACL will not benefit from nonsurgical methods and surgery is the best option for them. In general, ACL reconstruction is typically recommended for the following patients:

  • Are 40 years old or less
  • Have meniscal injuries associated with the ACL injury
  • Who regularly participate in pivoting activities and sports
  • Individuals with manual and outdoor jobs
  • Those who indulge in activities such as hiking, running, jogging, etc
  • Patients who experience buckling even during activities of daily living

Following ACL reconstruction surgery, the patient would be able to go home the same day. Before your discharge from the hospital, the orthopedic surgeon will provide a detailed set of post-operative instructions, a detailed physiotherapy program, and medications (to manage pain). 

Final Words

Unfortunately, non-operative treatments for an ACL injury including a physiotherapy program, rest and bracing are most likely to not fully restore stability of the knee joint.  As most patients are susceptible to repeated episodes of knee pain followed by physiotherapy programs, surgical treatment is usually recommended.

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