OH NO I've done my ACL .....

It’s the dreaded feeling  - the twist, the pop, the pain and the wobbly knee….

Many people have heard about people rupturing their ACL and the subsequent discussions
about surgery, rehab and time off sport (hear.. “season-ending injury“) but do we actually
know the best way to get that knee back to normal?

The anterior cruciate ligament (ACL) provides stability through the knee connecting the
femur (thigh bone) and the tibia (shin bone). It achieves this by preventing the sliding,
gliding and rotating of the knee joint. If you tear your ACL your knee may become swollen,
painful and feel weak or give way.

The goal of any treatment program is to restore knee stability, improve function and for a
safe return to sport, work and other activities. In the past we believed that to achieve a
good outcome and to get back to pivoting sports (including that social touch footy game), an
ACL reconstruction was required.

Usually, an MRI, a referral to an orthopaedic surgeon and a physio follow the injury in
various orders. And traditionally most active people have undergone an ACL Recon +/-
prehab beforehand and a 9-12 month rehab program afterwards.
Recent research has demonstrated that this “rule” of most people requiring a recon may
need to be rethought….

A new insight into ACL rehab

There have been a number of research projects and documented instances of ACLs healing
and /or people returning to their previous activities (including Elite sports people) without
undergoing an ACL recon and doing Rehab alone. !!!
The issue is we don’t really know just from scanning who will respond well to rehab without
surgery and those who most likely need surgery.

The general consensus is that an initial 3-month Rehab program with or without a bracing
protocol (chat to your health provider about this #crossprotocol #richardsonprotocol ) will
give your ACL the chance to heal (and quite a % do) and to see if you will cope without the
need for surgery. Regardless of surgery or no surgery , you will need to undertake a full
comprehensive program over the next 9-12 months and pass the return to sport tests.
The best thing is that if surgery IS required, and you’ve done the early work your outcomes
after surgery are improved, your muscles will be stronger, you should have good movement,
and all the bleeding and swelling will be gone.

Now let’s answer some questions about the rehab alone option …

Will my knee be “Stuffed” if I don’t get that early surgery?
Studies have shown that there is very little difference in outcomes between ACL
reconstruction surgery and rehab without surgery.

Both treatment options result in similar levels of:

• Knee function (like using stairs, running)
• Knee strength
• Activity levels
• Quality of life
• Knee pain
• Knee symptoms (like stiffness, swelling)
• Additional meniscus surgeries 
• Additional injury to the meniscus

Can I return to sport?

About half of all people with an ACL injury will return to the same level of sport, and this
is the same whether they choose ACL surgery or rehab without surgery
The most common reason people don't return to sport after ACL surgery is a fear of injuring
their knee again​.

***A successful outcome from rehab without surgery will mean that your knee feels great
and you regain full movement and function **** it is not settling for a second-rate
option.

Unfortunately, some people still have knee instability (knee collapsing or giving way under
them) after trialling rehab alone. For these people, there is a risk of damage to other parts
of the knee. In this case, surgery is recommended to prevent further knee damage.

We have grown up with the notion that ACL recons are the gold standard for getting back to
sport and our previous activities.
But ... there are always risks associated with any surgery, so if we can avoid unnecessary
surgery and still get a good outcome – Is this not the best option?
You can always get surgery if you feel your knee is not strong enough… at any time – It is not
an emergency.

The University of Melbourne has developed this great decision tool to help you get a non-
biased opinion and the evidence surrounding the decision to get surgery or to trial rehab.
https://www.aclinjurytreatment.com/treatment-options

If you have any questions/ comments about your options drop it in the comments or send
me a message.

*this advice is general and not specific to your injury. For more information or an
appointment, including telehealth, contact the practice > [email protected]

#TablelandsPhysio #Lithgow #Alliedhealth #ACLrupture #ACLrehab

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