Do I need ACL Surgery?

Assessing ACL Injury Severity

You just sustained an ACL injury. It probably hurt, your leg buckled and you probably thought: “This is not good!” How bad is the injury and what should you do about it? ACL surgery is one option, but not the only option.

Treatment options vary based on the severity of the ACL sprain or tear. There are three grades of ACL injury severity: sprain/tear level I, II and III. Level I is the most mild type of sprain, while in Level III injuries the ACL has been torn completely. A physical therapist, athletic trainer, or physician will be able to perform an Anterior Drawer Test for anterior cruciate ligament (ACL) stability and assess the severity of your ACL injury. Often an MRI is used to confirm the diagnosis.

I have an ACL sprain, what should I do?

If it is determined that you suffered a sprain you will be recommended to rest and ice for the initial period in order to let the swelling come down and make sure the leg doesn’t buckle on you, risking further injury. After that you should gradually resume regular activities and exercise and return to sport under guided supervision. You are most vulnerable for re-injury or even a tear immediately after the initial injury. However, you also don’t want to avoid movement and exercise altogether, a gradual progression is necessary to make sure you make a safe return as soon as possible.

What should I do after an ACL tear?

Some need surgery and others can continue to compete without their ACL. For some people surgery does offer an immediate solution. Typically, a surgeon can get you in for surgery from one day to two weeks after an injury. An ACL surgery will usually be followed by 9-12 months of rehabilitation. For others, especially athletes who need to finish out the season or their competition it is possible to delay surgery. In that case your knee will be braced and will loose some strength and power in the leg. While the knee may feel unstable, it is possible to compete without your ACL intact. For well-conditioned athletes who have enough leg strength, it is possible to delay surgery. Your therapist or athletic trainer will help you determine if you have enough strength to continue your competition.

Do I really need my ACL?

The ACL’s stabilizing function is similar to your car’s seat belt. The abbreviation “ACL” stands for “anterior cruciate ligament,” which serves
like a seat belt by keeping the top bone of your leg (the femur) from sliding on the bottom bone of your leg (the tibia) when you are cutting and planting. Much like when you are driving and slam on the brakes, the seat belt keeps you from flying forward. The decision whether you should have surgery now or later or if you just do rehab is personal and really depends where you are in life and in your career.

A good clinician will help you determine what makes the most sense for you. Please see the article below for additional information regarding treatment options.

Further reading (link will open in a new window): Harvard Health Letter: You’ve torn your ACL. Now what?