I've injured my ACL - do I need a reconstruction?

Unfortunately, ACL (Anterior Cruciate Ligament) ruptures are quite common - there are over 10,000 reconstructive surgeries performed in Australia each year (Janssen et al., 2011) .

These can be a pretty debilitating injury! They hurt a lot when they happen and they can fast track the development of osteoarthritis in the knee - not good news! 

Often, people with this injury are told they must have a reconstruction - a surgical procedure where part of the hamstring tendon is taken and used to replace the ACL. This can be a costly procedure and rehabilitation can be slow (4 months to return to running, 9-12 months to return to netball, basketball etc).  And even worse, the rerupture rate (or injury on the opposite side) can occur at a rate of up to 30% over the next 3 years in those under 20 (Feller et al, 2012). 

So is there another option?  Some recent research suggests that there may be.

Richard Frobell from Sweden and his colleagues came up with quite a clever study. They found 121 people with recent ACL ruptures. Half (62) had an ACL reconstruction straight away, and half (59) trialled rehab with the option of a reconstruction if they 'failed' rehab. 

Now these were quite sporty people! On a scale of 0 (sedentary) to 10 (elite sport), these people were between 5 and 9. 

Of the 59 that trialled rehab, HALF of them (29) - didn't need the surgery! Instead they performed some rehabilitation focused on strength, balance and sporting skills. 

Even better - 5 years later, the group that didn't have the surgery were as good as the group that had the surgery with regards to: 

 = how much osteoarthritis they had on XRay

 = how much sport they were able to play


So, the take home message is that, with proper rehab, you may be able to avoid surgery. Note this doesn't apply to everyone, and ACL injuries need to be considered on a case by case basis. Frobell's article is freely available on the excellent BMJ website here