Torn ACL May Heal Without Surgery
By Trying Knee Rehab First, Many May Avoid ACL Surgery
July 21, 2010 -- Many patients with a torn ACL -- the ligament that stabilizes the knee -- may avoid surgery by delaying the operation and first giving physical therapy a try.
One of the most feared sports and work injuries is a torn anterior cruciate ligament or ACL. It's the tough piece of tissue that keeps the knee from bending sideways when you plant your foot and pivot.
Nobody is exactly sure of the best way to treat a torn ACL. Yet every year, at least 200,000 Americans undergo ACL reconstruction, in which the ACL is restored with tendon grafts. Most patients undergo this surgery soon after their injury.
But that may not be the best strategy for everyone, suggests a clinical trial by physiotherapist Richard B. Frobell, PhD, of Sweden's Lund University, and colleagues.
ACL: To Operate or Not?
Frobell's team randomly assigned 121 young, active adults -- many of them highly competitive, non-professional athletes -- to two different treatments.
Both groups underwent a highly structured rehabilitation program in which they worked up from improving balance and coordination to knee strengthening exercises.
One group underwent ACL reconstruction within 10 weeks of injury. But the other group delayed ACL reconstruction until it became obvious they needed it -- or until they healed.
Two years later, both groups had good results. Neither treatment strategy was better than the other. But there was one big difference: 60% of those who delayed surgery found they never needed the operation.
"A lot of people say you need ACL surgery if you want to return to sports. But our results show we might be better off if we start with rehabilitation," Frobell tells WebMD. "Then we can reduce the number of people needing surgery."
Many Factors Involved in ACL Treatment
Mayo Clinic orthopaedic surgeon Bruce A. Levy, MD, is full of praise for the Frobell study. But he warns that some patients risk further damage to their knees by delaying ACL reconstruction.
The injury that rips the ACL may damage other parts of the knee, particularly the meniscus -- the piece of cartilage that cushions the bones of the knee.