What should you do if you tear your ACL?
The infamous ACL (anterior cruciate ligament) tear, reminding us of all the famous athletes like Derrick Rose, Tom Brady, Klay Thompson, the list goes on. It’s quite obvious when an ACL tear does happen. Often it is through impact/trauma, but sometimes it can even be precipitated internally. This is an injury that’s hard to miss too! As a ruptured ACL is a common injury (incidence: 68.6 per 100 000 patient years), when you do tear your ACL, there is a flush of intense pain in your knee associated with an audible pop. Moreover, when you attempt to stand, your knee will feel significantly unstable as there is no more ligament to stabilise lateral shift and so lower portion of your leg tracks medially.
But what is the consensus behind ACL tears? Which avenue do you take? How do you manage it and what is the most optimal way of managing it?
Firstly, this is a case by case decision that should be made together between the doctor, physio and especially the patient. Too many chefs do not spoil the broth, but together they give you a more informed holistic idea about management. A 2018 systematic review found that “A mean of 83% of competitive athletes return to their preinjury sporting level following surgery; this figure varies according to the type of sport in question. Similarly, 80% of amateur athletes return to sport following anterior cruciate ligament reconstruction.” However, we must read this in light of what defines a competitive athlete. Are they NBA stars? Are they players that are paid to play; and all the inferences associated with being a competitive athlete, i.e people who have weeks’ worth of time to rehab and have a whole career contingent on the success of their rehab. It is undeniable that there is evidence that anterior cruciate ligament reconstruction can lead to better quality of life, higher levels of sporting activity, and lower subjective instability than conservative treatment. However, ACL constructions should not be treated as a miracle pill. It needs to be matched with investment towards rehab; without rehab there may too be more complications.
But conservative treatment is equally viable. For the less than competitive population/ sedentary population of ACL tears, conservative treatment is sufficient to return to daily activities of living. Some studies report a non-significant difference between the two groups for an assorted population of ACL tears and 2 and 5 years post operation. This means that irrespective of which avenue you choose, there is no difference in the outcome, suggesting that it may not be worth the surgical complication risks to even undergo surgery. However, it is also stated that conservative treatment fails in a mean of 17.5% of cases.
Now that you know all this, how does it affect you? Reading this article should inform you of the risks and prognosis of both conservative and surgical paths. What I personally recommend whether you of any athletic status is to consider the conservative approach for roughly short of 1 year and if that avenue fails, then surgical procedure should be considered. Evidence is contended between what window is considered early and delayed. However, Church and Keating use 12 months as a marker to distinguish between early versus delayed. Anyone should always give themselves the potential to get better conservatively if people are returning to sport through conservative management (even professionals).