In years gone by an individual who sustains an anterior cruciate ligament (ACL) rupture has been managed with surgical interventions.
Recently however there seems to have been a push for research and investigations into the non-operative management of ACL ruptures with some arguing that it may be a superior or at the very least, a less risker approach compared to the surgical route.
Currently the literature in favour of conservative management for ACL rupture states:
- Surgery doesn’t prevent osteoarthritis or guarantee return to sport
- Primary goal of surgery is to create stability which can arguably be done with conservative management
- Regardless of a surgical or non-surgical approach the risk of knee lesions and osteoarthritis remains high
- No difference in pain, symptoms or function at five years follow up when surgical vs non-surgical patients are compared
- The ACL can heal itself in certain population groups
Despite what appears to be overwhelming evidence that conservative management may be effective for rehabilitating ACL injuries it must be mentioned that the literature at this stage is relatively poor. Better quality and larger research studies over a longer period are required.
However, I do agree that every patient who sustains an ACL rupture should be provided with the opportunity and time to complete a pre-operative rehabilitation program, ideally for three months with the opportunity to delay surgery based on criteria driven results. I think that we will start to see a lot more ACL ruptures managed without an operation in the not to distant future.