Nathan Ashby - Physiotherapist
“Not all ACL injuries need surgery because surgery doesn't always give the best results!”
What do we know about ACL injuries?
Research Results - The shocking truth!
Australia relies on surgery to fix the problem
In Australia 90% of ACL injuries undergo surgical repair.
This is compared to 50% in scandanivian countries, where avoiding surgery often gives patients faster rehabilitation and better outcomes.
5 years post surgery - surgical and non-surgical patients had the same results
When we look at people "returning to sport" after an ACL injury they are either successful at returning to their pre-injury level or sport, or unsuccessful if they don't get back to the same level. The research showed there was no difference in "return to sport" at 3 or 5 years post-injury for people who had surgery compared to people who didn't. As a result we started are starting to question the need for surgery in all ACL injuries.
The risk of secondary arthritic changes was the same for surgery and non-surgery groups
The research showed that surgical and non-surgical groups had the same chance of developing arthritic changes in the long term. As a result we believe it is the trauma of the injury that causes the risk of arthritis and not the choice of management.
How do I know if I need surgery?
Don't make the mistake of having surgery before you try rehabilitation - you may not need it.
The current recommendations for ACL injury are:
- Have an examination as soon as possible post-injury, you will need a scan to confirm the amount of damage.
- See a physiotherapist for initial recommentations: The most common recommendation is to give the knee time to settle using crutches or a brace, then trial early rehabilitation to see if you are a "coper" or a "non-coper". If it is clear you will be a "non-coper" then your physiotherapist will refer you back to your doctor for a surgical consult.
- After an initial period of rehabilitation (6-8 weeks) discuss with your therapist how your are progressing, this is a good time to consider surgery vs no-surgery.