Wait, there is a non-surgical option for me?
Yes! Many patients undergo the ‘rehabilitation first’ approach where they undergo a rehabilitation exercise program. The structures around the knee are strengthened in order to increase stability in the knee. Since surgery is not performed, this treatment approach mitigates the risk of complications that may arise from surgery such as infection, joint stiffness, pain and persistent instability. Additionally, this approach saves many patients the rigour of undergoing unnecessary surgery. Research has shown that 40% of patients function well with a torn ACL. This approach is most successful in patients:
- With partial tears and no instability symptoms
- With complete tears and no symptoms of knee instability during low-demand sports and are willing to give up high-demand sports
- Who do light manual work or live sedentary lifestyles
- Whose growth plates are still open (children)
In cases where instability persists, the option of surgery is still on the table and this rehabilitation pathway has shown to provide good outcomes too. On top of that, it has been shown that rehabilitation before surgery, also known as prehab, has significantly improved outcomes and increased return to play rates, when compared to no rehabilitation before surgery.
So, when will early surgery be indicated?
In cases where the ACL tear is coupled with a meniscus tear, early surgery is recommended. This is in order to restore the normal loading of joints and stability of the knee. Early surgery is also indicated for patients who plan to return to cutting and pivoting sports. Patients with a torn ACL and significant functional instability are at high risk of developing secondary knee damage, and hence, are indicated for surgery.
What does the rehabilitation approach look like?
Below are some of the exercises you might expect during your rehabilitation journey:
Knee extensions
Prone hamstring curls
Calf raises
Single leg bridge
Sit to stand
Wall squats
Star excursion
Single leg balance on foam
Step up
Regardless of your choice, it is important for you to be diligent in your rehabilitation!
How do I decide?
With every decision made, it should be an informed decision, involving your doctor, physiotherapists, and yourself. Pros and cons for each option should be weighed. While the ‘rehabilitation first’ approach might save you the cost of surgery, in the event of failure, it may end up being more expensive and the longest route to recovery. On the other hand, surgery might be costly and unnecessary for people who can cope with a torn ACL. Each treatment plan should be individualised and specific to each patient.
It is important for you to seek advice from a professional who will be able to advise you on what the best course of action should be.
Book now or give us a call to schedule an appointment to see our Physiotherapist who will be able to partner you to recovery after your ACL injury.
DISCLAIMER: These exercises should not replace the need for a consultation with a Physiotherapist, especially if your condition doesn’t improve with these exercises. Therapeutic exercise should be carefully selected to suit your condition.
References:
Moatshe, G., Kweon, C. Y., Gee, A. O., & Engebretsen, L. (2021). Anterior cruciate ligament reconstruction is not for all—a need for improved patient selection.
Filed under: Knee
