Surgery is not your only option for treating an ACL injury
Hundreds of thousands of people experience ACL tears per year, almost always athletes. However, injuring your ACL can happen to people who aren’t athletes as well.
The ACL is a ligament in the knee, and acts as a primary stabilizer in the knee for rotational movement. When you plant your foot to change direction, your ACL is the main ligament in your knee that allows for movement. Most often, ACL tears happen when playing sports like soccer, basketball, football and tennis – activities that require lots of changing of direction at a fast pace.
One of the most important things to remember when experiencing an ACL injury, is that the traditional orthopedic approach of jumping into surgery shouldn’t actually be be your first line of treatment. Physical therapy, stem cells, and other types of less invasive therapy might be your best option. Here is some advice to help.
Do
- consider conservative options
- look at biomechanical factors
- prevent the other knee injury
- make sure you understand tear type
- consider newer biologic therapies
Don't
- rush into surgery
- take NSAID’s
- look to the pros
Do consider conservative options
Most patients believe that if they injure their ACL, they must have it surgically replaced. However, many large research studies show that physical therapy works just fine. Initially, reduce inflammation with RICE: rest, ice, compression, and elevation.
Do look at biomechanical factors
Understand what biomechanical factors caused the injury. When we get injured it’s usually because we have put some sort of intolerable force on the muscular, skeletal, or joint areas of our body. Once we understand what biomechanical factors are to blame we can address those areas and strengthen them. Various research studies have shown that ACL injuries are associated with poor position sense and balance, weak hamstrings and glutes, improper landing, etc. Get a good physical therapist who specializes in sports or consider program like Egoscue posture therapy that will look at the biomechanical factors that may have caused the injury.
Do prevent the other knee injury
The other knee, the one that is uninjured, is 6 times more likely to get injured. Recent studies have shown that patients who injure one knee and get the ACL surgically replaced are 6 times more likely to either re-injure the same or other knee. Make sure that you look at the biomechanical factors in the other knee to prevent injury. See above.
Do make sure you understand tear type
Not all ACL tears are the same or require the same treatment. The three tear types are: partial, complete, complete retracted. The ACL can partially tear, which means some fibers still left. These generally will heal with time. The ligament can also completely tear and either still stay together or pull apart (a retracted tear). Biologic therapies like Prolotherapy and platelet rich plasma may be able to prompt healing in partial ligament tears. For full thickness tears, see below.
Do consider newer biologic therapies
An injection of your own stem cells may be able to completely heal bigger tears. In one case series of 10 patients, 7-8/10 saw good evidence of healing on post-injection MRIs and 8-9/10 saw improvements in pain and function despite having full thickness tears with retraction of up to 1 c.m.
Do not rush into surgery
Not all ACL injuries require surgery. You would think that we have high level scientific evidence that surgery is the best option. However, we really don’t. In fact, some studies show that physical therapy works just as well. In addition, other studies show that patients that opt for surgery frequently end up with arthritis. There is also the downside of a protracted recovery and always the risk of complications like infection when surgery is involved.
Do not take NSAID’s
NSAID’s, or Nonsteroidal Anti-Inflammatory Drugs are drugs like Ibuprofen, Aleve, Naprosyn, Motrin, etc. NSAID anti-inflammatory drugs are commonly prescribed, but several research studies show they can inhibit healing. Consider alternative options like fish oil capsules or ice.
Do not look to the pros
Professional athletes have a much different agenda when it comes to ACL repair than you. A 3 million dollar a year pro athlete trying to eke out another year or two on his contract has only one goal in mind, play for another year or two or three. You’re likely concerned about how the knee will fare for the next 10, 20, or thirty years. So focus on the long-term. ACL surgery was designed to repair the knee of the pro-athlete without much focus on the long term side effects.
Summary
When we get injured our first reaction is always to get better as soon as possible. However, it’s always best to slow down and take a long range view of not only treating the immediate injury but how that will affect the body and quality of life in the years to come. Patients should always be looking to avoid surgery unless it is inevitable.
