ACL Injury: Does It Require Surgery?
What are the General Guidelines in Australia Following an ACL Tear
Australia has the highest incidence rates of ACL reconstructions following an ACL tear in comparison to any other country. Approximately 90%(1). of ACL tears are surgically repaired in Australia compared to 50% in other countries such as Northern Europe.
The decision to have an ACL reconstruction can be difficult and several factors need to be considered before heading down the surgical path including the degree of injury, symptoms of instability and your activity levels.
In general, if you are a younger athlete wanting to get back into high-level sports that involve rapid changes of direction such as soccer or netball, most people will go down the surgical pathway to have an ACL reconstruction(1).
|
Why are ACL Reconstruction Rates so High in Australia
Can You Function Without an ACL?
Are There Any Risks Involved with an ACL Reconstruction
There are risks involved with an ACL reconstruction as there is with any surgery including an increased risk of developing blood clots and infection. Additionally, the ACL graft is harvested from either the hamstring or patella tendon so there is risk of having permanent damage, pain and dysfunction at those sites following an ACL reconstruction(11).
|
So, should I Have an ACL Reconstruction?
1. Zbrojkiewicz D, V.C., Grayson JE, Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015. Med J Aust, 2018. 208(8): p. 354-358.
2. Smith, T.O., Postle, K., Penny, F., McNamara, I., & Mann, C, Is reconstruction the best management strategy for anterior cruciate ligament rupture? A systematic review and meta-analysis comparing anterior cruciate ligament reconstruction versus non-operative treatment. The Knee, 2014. 21((2)): p. 462-70.
3. Delincé, P. and D. Ghafil, Anterior cruciate ligament tears: conservative or surgical treatment? Knee Surgery, Sports Traumatology, Arthroscopy, 2013. 21(7): p. 1706-1707.
4. Grindem, H., et al., A pair-matched comparison of return to pivoting sports at 1 year in ACL-injured patients after a nonoperative versus operative treatment course. The American journal of sports medicine, 2012. 40(11): p. 2509-2516.
5. Nordenvall, R., et al., Cruciate Ligament Reconstruction and Risk of Knee Osteoarthritis: The Association between Cruciate Ligament Injury and Post-Traumatic Osteoarthritis. A Population Based Nationwide Study in Sweden, 1987–2009. PLOS ONE, 2014. 9(8): p. e104681.
6. Sanders, T.L., et al., Is Anterior Cruciate Ligament Reconstruction Effective in Preventing Secondary Meniscal Tears and Osteoarthritis? The American Journal of Sports Medicine, 2016. 44(7): p. 1699-1707.
7. Gupta, R., et al., Delay in surgery predisposes to meniscal and chondral injuries in anterior cruciate ligament deficient knees. Indian Journal of Orthopaedics, 2016. 50(5): p. 492-498.
8. Filbay, S.R., Early ACL reconstruction is required to prevent additional knee injury: a misconception not supported by high-quality evidence. British Journal of Sports Medicine, 2018.
9. Costa-Paz, M., et al., Spontaneous Healing in Complete ACL Ruptures: A Clinical and MRI Study. Clinical Orthopaedics and Related Research, 2012. 470(4): p. 979-985.
10. Fujimoto, E., et al., Spontaneous healing of acute anterior cruciate ligament (ACL) injuries – conservative treatment using an extension block soft brace without anterior stabilization. Archives of Orthopaedic and Trauma Surgery, 2002. 122(4): p. 212-216.
11. Konrath, J., Vertullo, C., Kennedy, B. A., Bush, H., Barrett, R., & Lloyd, D. , MorphologicCharacteristics and Strength of the Hamstring Muscles Remain Altered at 2 Years After Use of a Hamstring Tendon Graft in Anterior Cruciate Ligament Reconstruction. . American Journal of Sports Medicine, 2016. 44(10): p. 2589–2598.
12. Eitzen, I., et al., A Progressive 5-Week Exercise Therapy Program Leads to Significant Improvement in Knee Function Early After Anterior Cruciate Ligament Injury. The Journal of orthopaedic and sports physical therapy, 2010. 40(11): p. 705-721.