Facing ACL Surgery? Key Signs and Essential Next Steps

Jan. 29

So you’ve been told you may have torn your ACL. What do you do now? What could this mean for your future lifestyle? Is surgery the only option? This article explores what an ACL injury is and the facts behind how to decipher which rehabilitation route is right for you.

What is an ACL Injury?

The Anterior Cruciate Ligament (ACL) is one of four ligaments in the knee that attaches from the femur (thigh bone) to the tibia and fibula (shin bones). Its main functions are to stabilize the knee by limiting forward tibial translation, limiting tibial rotation, as well as providing awareness of where the knee is in space (proprioception).

ACL ruptures are one of the most common ligament injuries found in people between the ages of 15-45 who have an active lifestyle and are participating in sports such as skiing, volleyball, tennis and soccer. A tear can happen through direct contact and non-contact force generated by the body’s own momentum. Tears typically occur with sudden cutting, pivoting, twisting and changes in direction with the foot firmly planted. Patients might also hear a pop, experience a lot of pain, swelling and note a sense of instability in their knee. A torn ACL is typically diagnosed with a series of physical tests and confirmed with an MRI.

If I tear my ACL Do I need Surgery?

Not necessarily! It all depends on your lifestyle and whether or not you can “cope” without an ACL.

Copers vs non-copers

A coper is defined as an individual who showcases excellent dynamic stability in their knee despite having their ACL torn. This means, that under supervision from a physiotherapist, they are able to rehab their knee to full function, normalized sensation of stability and are pain-free despite their torn ACL. They are able to return to sport without ACL reconstruction surgery while having no limitations.

In comparison, a non-coper is someone who demonstrates consistent dynamic instability in the knee and feels that their knee is shifting in their everyday life despite doing rehabilitation. They might not trust their knee in certain activities as it can feel that the knee is “slipping” or that a re-injury could happen.

Can I become a coper?

With proper rehabilitation through progressive neuromuscular and strength training (NMST), there is a possibility that non-copers can become copers and surgery may not be required.

Benefits and risks of ACL surgery vs conservative care

Surgery:

Benefits:

Increased structural stability
Improved outcome for non-copers to get back to sport, daily physical activities and quality of life

Risks:

Recovery is a long process that can take 10 months to 1 year before getting cleared to return to sport.
It takes a significant level of mental and physical commitment to have a successful recovery.
There is still the possibility that you might never get back to full pre-injury ability in your sport
15% greater risk of re-injury

Conservative care:

Benefits:

A systematic review conducted by Rodriguez et al (2021) found that patients who chose not to do surgery and began a solid rehabilitation program had satisfactory outcomes so long as their activities were not competitive or could be altered to avoid high contact sports.
For copers, there is a greater likelihood to return back to sport within the first year of injury.

Risks:

If it is a complete ACL rupture, there is a greater likelihood of having instability in the knee without surgical intervention. Secondary damage could occur for patients who experience instability (non-copers).

Conclusions

After an ACL rupture, surgery is not the only option for a full recovery. Whether you get surgery or not, prehabilitation and rehabilitation through progressive neuromuscular and strength training (NMST) is crucial to build up strength, stability, and neuromuscular control. It is recommended that non-surgical rehabilitation begins within 2 weeks post-injury to achieve optimal results. Additionally, whether you get surgery or not, the risk of re-injury or further injury is increased, especially through the participation of activities that involve lots of quick pivoting and cutting. What is most important to understand is that whether you get surgery or not, a proper rehabilitation program will significantly improve the overall knee function, strength, and mobility.

Key Considerations and Takeaways:

Listen to your healthcare professional, you can always seek advice from a Victoria chiropractor or physiotherapist
Take into account the severity of injury (minor partial tears vs a complete tear)
Whether you may be classified as a coper or non coper
Your lifestyle, sports and activities, and whether you participate in competitive sport

References:

Rodriguez K, Soni M, Joshi PK, et al. Anterior Cruciate Ligament Injury: Conservative Versus Surgical Treatment. Cureus. 2021;13(12):e20206. Published 2021 Dec 6. doi:10.7759/cureus.20206

Thoma LM, Grindem H, Logerstedt D, et al. Coper Classification Early After Anterior Cruciate Ligament Rupture Changes With Progressive Neuromuscular and Strength Training and Is Associated With 2-Year Success: The Delaware-Oslo ACL Cohort Study. Am J Sports Med. 2019;47(4):807-814. doi:10.1177/0363546519825500

Dana Tostenson, MPT

With a passion for people and health, physiotherapy has been a natural fit for Dana.

He enjoys working with clients through a holistic approach; incorporating manual therapy, tailored exercise prescription, and evidence informed education to help his patients overcome their pain, improve performance, and enhance their overall health.

Victoria, BC physiotherapist Dana is excited to help people return to the activities they love, approaching any issue, big or small, with enthusiasm and compassion. As a former varsity athlete and now a recreational competitor, his passion for sports and performance optimization makes him a great fit for injured athletes or weekend warriors hoping to return to and excel in the game.

Dana is a graduate of the University of British Columbia (Masters of Physical Therapy), the University of Alberta (Bachelor of Science in Nutrition), and has completed his Transitional Doctorate in Physical Therapy. He has advanced training in Functional Dry Needling, joint manipulation, chronic pain management, nutrition, as well as vestibular and TMJ disorders.

Outside the clinic you can find Dana on the jiu-jitsu mats, taking in the island’s natural beauty, or tending to his admittedly too many house plants (which have now spilled into the clinic).