ACL Reconstruction
What Is an ACL?
ACL stands for anterior cruciate ligament. That is a fancy name, but it is really just a strong band of tissue inside your knee, that connects your thigh bone (femur) to your shin bone (tibia).
Think of the ACL as a rope that stops your shin from sliding too far forward compared to your thigh. It also helps keep your knee stable when you twist or turn quickly. Without a working ACL, your knee may feel like it is “giving out” when you try to change direction [1].
The ACL is one of four major ligaments in the knee, but it gets injured regularly and is the one most discussed in sports.. About 200,000 people in the United States tear their ACL every year.
How do I know if I Might Need ACL Surgery?
This is one of the most common questions. The answer is: it depends. Not everyone with a torn ACL needs surgery. Orthopedic Specialists look at three things to decide.
1. Your activity level
If you want to play sports that involve running, jumping, cutting, or twisting like soccer, basketball, football, tennis, or skiing, you probably need surgery. Without an ACL, your knee will keep giving out, and you will damage other parts like your meniscus (the knee’s shock absorber) [2].
If you are older and only want to walk in a straight line, swim, or bike, you may not need surgery. Many people live perfectly well without an ACL by doing physical therapy to strengthen the muscles around the knee.
2. Your age
Young, active people do better with surgery. Older adults (over 50–60) sometimes choose non-surgical treatment because their activity level is lower and the issues associated with surgery may outweigh the benefit.
3. Your knee stability
Some people tear their ACL but still have a decent knee because their muscles are very strong. Doctors will examine your knee and use special tests to measure how much your shin moves forward. If the movement is small, you might skip surgery.
If your knee gives out when you try to play sports, you likely need surgery. If you can do everything you want without the knee buckling, you may not.
Can an ACL Tear Heal Without Surgery?
Here is a surprising fact that many doctors did not believe until recently. Some ACL tears can heal without surgery, but not all. For many years, experts said the ACL cannot heal because it has poor blood supply and the two torn ends float in joint fluid. However, new research shows that a specific type of ACL tear, one where the ligament pulls off the bone with a small piece of bone still attached (called an avulsion fracture), can sometimes heal if the knee is placed in a brace [3].
But for most complete ACL tears where the ligament snaps in the middle, healing without surgery is unlikely. You may still have a functional knee if you build strong leg muscles, but the torn ligament itself will not reconnect.
Do not count on natural healing. Most ACL tears require either surgery or a very good rehab program to stabilize the knee without surgery.
Will I Ever Play Sports Again?
Yes. Most people return to sports after ACL reconstruction. But the exact number depends on the sport and your commitment to rehab.
Your best chance of playing sports again after ACL surgery is to:
- Complete all of the rehab and Physical Therapy
- Do not return to cutting or jumping until your leg strength is equal on both sides
- Learn to land and cut with good technique to protect your knee
Many people say their knees feel even stronger after surgery because they spent so much time strengthening their legs.
An ACL tear is scary but an Orthopedic Specialist can put together a plan to get you better. Thousands of people go through it every year and come back to sports. You will need patience, hard work, and physical therapy. But if you love your sport, you can almost certainly play again. Come see us at The Orthopedic and Sports Medicine Institute if you are concerned about persistent pain or suspect an injury. Our goal at the Orthopedic and Sports Medicine Institute (OSMI) is to provide our patients with quality, cutting-edge orthopedic treatments, both surgical and non-surgical. If you would like to book an appointment, please submit an online appointment request or contact our office. We have clinic locations in Fort Worth, Mansfield, Decatur, and Willow Park.
Remember: not everyone needs surgery. But if your knee buckles when you try to move sideways, surgery is likely your best path. And no matter what, give yourself time to heal. Your knee will thank you.
References
- Musahl V, Karlsson J. Anterior Cruciate Ligament Tear. N Engl J Med. 2019 Jun 13;380(24):2341-2348. doi: 10.1056/NEJMcp1805931. PMID: 31189037.
- Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011 Jun;45(7):596-606. doi: 10.1136/bjsm. 2010.076364.
- Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019 Feb;33(1):33-47. doi: 10.1016/j.berh.2019.01.018. Epub 2019 Feb 21.
- Pitsillides A, Stasinopoulos D, Giannakou K. Healing potential of the anterior cruciate ligament in terms of fiber continuity after a complete rupture: A systematic review. J Bodyw Mov Ther. 2021 Oct;28:246-254. doi: 10.1016/j.jbmt.2021.06.003.
- Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med. 2016 Jul;44(7):1861-76. doi: 10.1177/0363546515621554.