ACL Blog #1 in a series of ACL related posts
Can you function well after a complete ACL Tear? Do you ABSOLUTELY need surgery?
You’re in the middle of a great run down the field, running past every opponent you see, ball in hand, you’re running running running! An opponent stands in your way so you decide that you are going to take a quick step to the left and then turn to the right to trick your way past him…. You do exactly that but as you do, you feel your knee give way and you go down to the ground! The trainers rush to the field to check on you, the physio grabs your knee and gives it a quick wiggle and says what no athlete wants to hear.
You’ve done your ACL mate.
Following this you here opinions left and right from friends and family members, doctors and surgeons, “You need to get that repaired.” They say. “If you want to play high level sport again you have to get your ACL replaced…”
But do you?
Lets take a look at some high level athletes stats and achievements in their respective sports:
Hines Ward: Two-time super bowl champion played 217 games and made 1,000 catches for 12,083 yards as a wide receiver. Along with this, after retirement he also ran an Ironman triathalon.
DeJaun Blair: played 450 games in the NBA for the San Antonio Spurs, Dallas Mavericks, and Washington Wizards at a height of 2.01 metres and weight of 122 kg.
Peter Wallace: Won the John Farragher award for Courage and Determination running over 900 metres and making over 800 tackles in one season.
What do these athletes all have in common apart from excelling at sport…..They all tore their ACL’s and did not get them reconstructed.
We even know of athletes who have completely torn their ACL’s and continued playing the same game regardless of the tear. Peter Wallace did just that playing an extra 50 minutes of a game after he tore his ACL. Mitch Short of the NSW Waratahs did the same when he ruptured his ACL on his Super Rugby debut against the Sharks in Durban, but was still able to play out the rest of the game and make his first start just two weeks later in the derby win over the Rebels.
These individuals are what we call ‘copers’.
“those who use some complex neuro-musculo-skeletal strategies to dynamically stabilize their ACL-minus knee and are able to return to their professional sport at their pre-injury level” (1).
“individuals who exhibit knee instability and use different strategies to be able to have normal daily activities (1)”
Simply put, copers usually need an ACL repair and non-copers usually don’t. A quick way to see if someone is a coper or a non-coper is seeing how they go with their balance (1). Can they do certain balance tests without their knee giving way? Yes, then they will probably do well with a conservative approach to their rehab, completely bypassing surgery and starting a physiotherapy program as soon as possible.
As physiotherapists we are experts in determining if you will be able to go with or without an ACL reconstruction and can guide you through a rehab program dedicated to getting you back to what you enjoy doing.
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Chmielewski T, Rudolph K, Synder-Mackler L. Development of dynamic knee stability after acute ACL injury. J Electromyogr Kinesiol 2002; 12: 267–274