Can an active adult male avoid surgery for an ACL tear and return to normal activities, even if his knee is unstable? This week’s Ask Dr. Geier column answers the question from a reader in Nepal wanting to know if he can avoid surgery for an ACL tear.
I had an ACL tear nearly one and half months earlier, and now I’m referred for ACL reconstruction surgery. Nowadays, I can walk gently on plain land without pain and can bend my knee easily, but I have an unstable sway action side-wise. Under these circumstances can I avoid surgery?
The anterior cruciate ligament (ACL) is a thick, strong ligament in the center of the knee that provides stability to the knee. When an athlete or active individual tears the ACL, the ligament does not heal on its own.
The problem with having a torn ACL
The fact that the ACL doesn’t heal itself in and of itself isn’t really the reason orthopedic surgeons often recommend ACL reconstruction – surgery to make a new ACL. Without any intact ACL, a patient often notices that his knee buckles or gives way with activity. Landing from a jump or planting the foot to change directions can often be difficult and cause the knee to buckle. That instability is the main reason athletes who play sports that involve cutting and pivoting movements almost always require ACL reconstruction to return to play.
Should you avoid surgery for an ACL tear?
If a patient has an unstable knee, he risks doing more damage to other structures in the knee. Secondary meniscal tears and articular cartilage damage can potentially occur with continued instability. If a patient has a knee that gives way frequently, even with activities of daily living and not just sports, we often at least discuss surgery.
It is possible, though, to avoid surgery after an ACL tear. Some people can perform their daily activities and even run, walk or lift weights for exercise without experiencing instability. For less active patients, an ACL brace can be an option as well. It is important for any patient who tears his ACL to discuss the risks and benefits of both surgical and nonsurgical options for an ACL injury.
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