ACL Repair

Do I Need to Have ACL Surgery?

Dr. Christopher Wahl, MD
Orthopedic Surgeon OPA
Seattle

Let me tell you a secret; not everyone who tears their anterior cruciate ligament (ACL) needs to have an ACL reconstruction.  The fact is that in a room full of orthopaedic surgeons, you can't throw a cat without hitting a few who have ACL tears and chose to avoid surgery.  The "honest" surgeon doesn't operate on every knee with a torn ACL; rather, the surgeons should assess the likelihood that an ACL reconstruction will actually benefit the patient based on his or her activity level, age, and risk for continued instability or ongoing injury to the knee.  A very simplified grouping algorithm looks like this:

1. Young and/or active patients who engage in athletics and high-demand activities (jumping, cutting, acceleration/deceleration sports such as skiing, soccer, volleyball, basketball, tennis, football) should undergo an ACL reconstruction. Participating in these activities with an unstable, ACL-deficient knee can cause injury to other structures in the knee (meniscus, articular cartilage, etc.). These patients are strongly advised to consider an ACL reconstruction in order to protect the knee from further injury.
   

2. Athlete or not, patients who have an ACL tear and experience knee instability with regular daily activities, despite having undergone appropriate knee rehabilitation, should consider undergoing an ACL reconstruction. These patients have "functional instability"--or the inability to carry out routine daily activities without giving way episodes. As above, these patients are generally counseled to consider ACL reconstruction to stabilize the knee and avoid further or future injury if the knee does not respond to physical rehabilitation and prevention programs.
   

3. Patients who rarely participate in high-demand activities such as cutting, jumping, landing, acceleration or deceleration sports and have rehabilitated the knee to the point that they can engage in their usual activities without a sense of giving waycan avoid ACL surgery. In this population of patients surgery is not recommended; they are probably as or more likely to have a more successful result without ACL surgery than with it--the recovery will certainly be shorter, less painful, and has no risk of surgical complications.

So, before signing up for surgery to reconstruct your ACL, think about your activity level, current level of function and comfort, activity goals, etc and decide with your surgeon what the best treatment option is for you and your knee.    able to see the “scene of the crime” in real time is a helpful part of the analytical process.

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