New road to recovery for ACL injuries

Operations may not be necessary for the common knee injury as study finds ‘rehabilitation first’ could have similar benefits to surgery for Anterior cruciate ligament (ACL) injuries.

Dr Patrick Owen

The road to recovery for ACL injuries may look very different with a new study suggesting surgery may not always be necessary. 

If you’re interested in sport, chances are you’ve heard of ACL ruptures. They’re one of the most common and serious knee injuries, most often treated with knee surgery followed by a rehabilitation program.  

However, a study conducted by a team of researchers from the Institute for Physical Activity and Nutrition (IPAN) at Deakin University and Hochschule für Gesundheit in Germany found that knee function could be significantly improved regardless of which of the two treatment paths were chosen.  

The research team also found that early surgical reconstruction of the ACL had no protective effect against knee osteoarthritis occurring in the future – although further studies are needed.  

The study, published in the British Journal of Sports Medicine, analysed nine publications from three different randomised trials. Researchers compared the two different therapeutic approaches for an ACL tear. The team compared the outcomes of operating shortly after the injury to the rehabilitation therapy approach, in which the patient first receives rehabilitation and surgery is only provided if it is still deemed necessary afterwards. 

IPAN’s Dr Patrick Owen said the findings challenged the current approach of rushing to surgery as the default first option.  

“Since there were no clinically meaningful differences between the treatment approaches, we propose a patient-centered form of care,” he said.  

“Treatment should be individualised to take into account each patient’s medical situation and demands of daily life and/or sports.” 

“We need to rethink the status quo medical advice around these injuries and weigh up the pros and cons of each course of action,” Dr Owen said. 

The researchers found a slight advantage towards immediate ACL reconstruction for patients who had meniscus damage of the knee, although the evidence was of low certainty. 

Dr Owen said this study could potentially support professional athletes returning to training either with or without surgery, but that further research is needed. 


[Image by Scott McNaughton (photographer)]