ACL Surgery: Do you need one?
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 rupture. This blog will shed light into some of the main factors to consider before making a decision.
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).
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.
Based on your lifestyle, each of these parameters will have differences in weight during the decision-making process. For some of you, the decision will be a no-brainer on either surgery or conservative management. As clinicians, our responsibility is to deliver the evidence so that you’re are well informed. This will allow you to make the best decision!
Van Yperen et al. Twenty-Year Follow-up Study Comparing Operative Versus Nonoperative Treatment of Anterior Cruciate Ligament Ruptures in High-Level Athletes. AJSM (2018).
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