An ACL rupture is a major injury that could potentially influence the remainder of someone’s sporting life. There is a lot of debate and accumulating evidence on whether or not someone should get an ACL reconstruction following a rupture. This blog will shed light on some of the main factors to consider before making a decision.
Sport
Understanding the demands of sports based on the type of sport and the level to which it’s played is a major contributing factor when considering having surgery. Sports such as soccer, rugby, and basketball require a great amount of stability due to cutting, pivoting and change of direction movements. This level of stability is difficult to replicate with strengthening and stability exercises. Hence surgery is typically the best option to allow you to return back to sports of these physical demands.
If you want to return to everyday life, running, cycling and the occasional weekend hike, then rehabilitation without an ACL will allow you to achieve these goals. There is also evidence to show that living without an ACL does not increase the likelihood of osteoarthritis (Van Yrepen et al 2018).
1. Can I avoid surgery if I tear my ACL?
In many cases, yes! For people who don’t do lots of pivoting sports, or whose knee doesn’t “give way,” a well-structured rehab program can help restore function. Studies show that about 50% of people who start with exercise-based rehab avoid needing surgery. This decision comes down to your current and future needs, and how well your knee is “coping” at the moment.
2. What are the signs that surgery is likely the best option?
Here are some concerns where surgery is more likely the right path:
- If your knee repeatedly “buckles” or gives way during daily life or sport.
- If you want to return to sports requiring cutting, pivoting, or rapid direction changes.
- If there are additional injuries (e.g. to the meniscus, cartilage) in your knee.
3. What does non-surgical rehab look like?
Non-surgical rehab usually includes:
- Strengthening your quadriceps, hamstrings, hips and stabiliser muscles.
- Balance, proprioception, and neuromuscular control work.
- Using braces in some cases for support during rehab.
- Modifying activities (especially avoiding high-risk moves) until your knee is stable enough.
4. How long does recovery take (whether I go with surgery or not)?
Rehabilitation takes time. There are no quick fixes. Even with surgery, full return to sport often takes 6-12 months, depending on how intense the sport is, how dedicated you are to rehab, and how strong & stable your knee becomes. For non-surgical paths, recovery might be slower or have limitations, especially for high-demand activities.
5. What are the risks of delaying or skipping ACL surgery?
Avoiding or delaying surgery isn’t necessarily bad, but there are trade-offs. Possible risks include:
- Continued instability → more strain on other parts of your knee (meniscus, cartilage) which can potentially lead to accelerate degenerative changes.
- Potential for additional damage if the knee “gives way” often.
- May limit return to high-intensity sport or risk performance/re‐injury if demands are high without adequate stability.
Age
Age has a large role to play in making a surgical decision. Typically, older patients whose sporting needs are more for fitness and lifestyle would be better suited towards a conservative approach to treatment. When you drop down a bracket to 35-50, these decisions will depend on the level of sport and if playing is an income source. However, a 37-year-old footballer on the brink of retirement may elect not to get surgery based on his/her sporting future. For young adults (18-35) the decision of surgery will be based on lifestyle factors such as what sports they wish to play, work commitments, etc.
Effort and Time
Are you willing to put in the effort!? Many clinicians DON’T educate patients on how long an ACL rehab program takes. And more importantly, the level of effort they need to sustain during rehab and long-term if you want to continue playing. It’s important, you’re made aware of these factors and accept the responsibilities in this process. This will help you be realistic about your expectations throughout the process.
