Understanding Your Options After an ACL Injury
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Anterior cruciate ligament (ACL) injuries are common, especially in sports. If you or someone you know has experienced an ACL tear, the next step often involves making a big decision: surgery or rehabilitation. A recent Australian study explored how patients made this decision and found that many felt overwhelmed and under-informed.
What Is an ACL Injury?
The ACL is a ligament in your knee that helps keep it stable. It can tear during sports or physical activity, often from a sudden twist or impact. Once torn, the ACL does not heal on its own. However, that doesn’t always mean surgery is necessary.
What Are the Treatment Options?
There are two main options:
- Surgery (ACL Reconstruction): Replacing the torn ligament with a graft.
- Rehabilitation (Physiotherapy): Strengthening the muscles around the knee to support it.
Research shows that both treatments can lead to similar long-term results for many people.
What Did the Study Find?
The study included 734 Australians with ACL injuries. Most had surgery, but about 16% managed their injury with physiotherapy alone.
Here are some key findings:
- Surgeons favored surgery. 85% of orthopedic surgeons told patients it was the best option.
- Other healthcare providers followed suit. Many general practitioners and physiotherapists also leaned toward surgery.
- Few explained that both treatments could be equally effective. Only 10–29% of clinicians shared this fact.
- Patients often felt pressure. Some were rushed into surgery without fully understanding the alternatives.
- Information was inconsistent. Different healthcare professionals gave mixed messages, leaving patients confused.
The Problem with One-Sided Advice
Many patients said their surgeon told them surgery was the only way to return to sport. Others reported being scared into surgery by warnings about long-term problems, like arthritis or reinjury. But these risks exist for both treatment paths.
Also, some clinicians didn’t mention the recovery time, pain, or effort involved in surgery. For example, returning to sport after surgery can take 9–12 months and isn’t guaranteed. In fact, fewer than 60% of people return to their previous level of sport.
The Role of Physiotherapists and GPs
Physiotherapists provided more balanced advice in some cases. A few encouraged patients to try rehab first and reassured them that surgery wasn’t the only option.
GPs were mostly used to get referrals, not treatment advice. Many patients said their GP didn’t discuss treatment options in detail.
So, What Should You Do?
If you have an ACL injury, here are some practical tips:
- Talk to More Than One Expert: See both a physiotherapist and a surgeon. Each will offer a different perspective. Ask questions and take your time deciding.
- Ask About Both Options: Make sure you're informed about the benefits and risks of surgery and rehab. Recovery timelines, costs, and outcomes should be part of the discussion.
- Be Aware of Bias: Some clinicians may unintentionally push for surgery, especially if that's what they're trained to do. Remember, you're allowed to explore other options.
- Consider a Decision Aid: Look for online resources or tools that explain your choices clearly. The study led to the creation of a free patient decision aid at aclinjurytreatment.com.
Conclusion
An ACL injury is serious, but the treatment decision should be yours. Take the time to understand your options, get balanced advice, and choose a path that fits your goals, lifestyle, and values. Surgery isn’t the only way forward—and for some, it might not be the best one.