ACL non-surgical management
ACL is short for anterior cruciate ligament and is one of the interior ligaments of your knee. It is a commonly injured ligament playing some of our favourite sports; in particular AFL football which has one of the highest incidences of ACL injury of any sport.
Australia has the highest rate of reconstruction surgery in the world and our current healthcare system is set up to fast track you to the operating theatre. So that begs the question, should we be so quick to reconstruct and what evidence do we have to suggest that this approach is the correct one?
A recent systematic review of the literature suggested that the research is heavily skewed toward a comparison of surgical management as it showed that only one (the KANON study) of 412 ACL randomised controlled trials compared ACL surgical to non-surgical management. The other 411 compares types of graft and surgical approaches.
The KANON study recommended that “the results should encourage clinicians and young active adult patients to consider rehabilitation as a primary treatment option after an acute ACL tear”.
Not only that but more and more studies are showing that ACLs can heal completely by themselves despite the previous belief that this was impossible due to lack of blood clot formation.
But wouldn’t a surgically repaired ACL be better?
Well, research is showing that patients who received the surgical intervention were prognostically worse across multiple domains in comparison to non-surgical and delayed surgical arms. The researchers have stated that this may be due to a ‘secondary trauma’ due to the surgical drilling through intra-articular structures, a period of prolonged inflammation, and altered weight-bearing. This increases the rate at which people develop osteoarthritis in comparison to that non-surgically managed.
Researchers are highlighting the “emerging realisation that athletes may be over-treated with ACLR, but undertreated when it comes to rehabilitation”. But don’t you need an ACLR if you want to return to sport? Well, not necessarily. In fact, there are a growing number of athletes electing to forgo the surgery overseas. Most famous of which is an English Premier League soccer player who returned to soccer eight weeks following a full-thickness ACL rupture and remained problem-free long-term!
If you have any questions regarding ACL injury management, give us a call on (08) 8296 1755 to book your assessment.