Torn ACL May Heal Without Surgery
By Trying Knee Rehab First, Many May Avoid ACL Surgery
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Many Factors Involved in ACL Treatment continued...
"If you have a large meniscus tear and you fix the meniscus and not the ACL, there is a very high likelihood the ACL will fail," Levy tells WebMD.
On the other hand, a patient who is a relatively low-level recreational athlete -- Levy offers the example of a 35-year-old cyclist -- may be better off with bracing and rehabilitation. Only if such patients have further ACL problems would surgery be the preferred option. But a collegiate soccer player might not be able to return to play without ACL reconstruction.
"When a patient presents with an ACL tear in the knee, we have a long discussion with the patient and family on the pros and cons of operative and nonoperative treatment," Levy says. "The decision is based on many factors. First and foremost is the patient's activity level, and the sport and work demands the knee would undergo."
Frobell fully agrees with Levy that the study does not give patients or doctors a one-size-fits-all solution to treatment of ACL tears.
"Our study does not answer the question of specifically who needs ACL surgery. It does not look into what factors a patient has to have to need surgery to do well," he says. "We need a lot of more high-quality science in this area."
Some of that data may be coming soon. Levy says he'd like to see how Frobell's patients do in the long term. Frobell says the last patient in the study is just completing five years of follow-up observation. More information is on the way.
The Frobell study, and an editorial by Levy, appear in the July 22 issue of the New England Journal of Medicine.