Is ACL Surgery Really Necessary | Fighting Fit Physiotherapy

We have all seen on the TV a teams marque player go down on the field and commentators go off on the TV that the player has just ended their season.

“They have done their ACL, that is the season done and we will see them back in 12 months.

It’s going to be a long road ahead”

A common scene from the football codes is a player painfully going down and holding their knee.

They know what’s up and the time it is going to take to get back!

The Bias Toward Surgery!

There is so much emphasis into the surgical rehabilitation of an ACL with our elite athletes that we see a big cross over into the every day recreational athlete, weekend warrior or social sports enthusiast.

So now when anyone tears or Rupture their ACL, they NEED SURGERY!

It has almost become routine that if we see this ligament torn or ruptured on MRI that we head off to the orthopaedic surgeon and undertake an ACL reconstruction without any consideration to other options.

But new an exciting evidence is beginning to appear that contradicts the need for this in many cases.

Recent studies have demonstrated healing capacity of the ACL with conservative management, scarily some of these even date back to 2011.
The risk of osteoarthritis may actually be greater in an ACL reconstructed knee then a non reconstructed knee
There are many athletes at the top level of their sport playing in the NBA, NRL, NFL, EPL all without ACL’s (well at least last time they checked it may have grown back)
You can still function at a very high level in sport without an ACL!

Above a case of rupture (left) and 3 month after (right) injury (Credit: Dr Louise Tulloh)

Why is this only just coming out?

Routinely, many ACL injured patients just whip off for surgery straight away, or at least within 6 or so weeks post injury, because it has long been thought this was the best practice for improved long term outcomes for return to sport.

Moreover, the patients that don’t have surgery and just quit sport to live, are rarely, if ever are re-scanned to check.

For the first time EVER!

This year in the clinic we have seen MORE NON OPERATIVE management of and ACL tear or rupture than we have OPERATIVE management.

How cool is that!

The Pro's & Con's LIST!

Some of the PRO’s we have seen from going conservative!

A quicker time to return to sport (as low as 6 weeks, up to 4 months if includes an MCL injury)
No painful surgery required
Quicker return of normal knee range of movement
Faster return of bulk and activation of the quadriceps and surrounding muscles
Equal hamstring strength (many post ACL never return normal hamstring function post surgery)
Less risk of complications from surgery eg excessive pain, swelling, DVT
Less pain and impact on normal life, quicker return to work and everyday tasks
A better ACL quality of life score following injury then following surgery
Better outcomes even if they end up going onto surgery later on

Some of the CON’s we have experienced!

Episodic knee instability with sport
Re-injured and gone onto have surgery

When may ACL reconstruction be required?

There are some conditions that when seen really do require surgical intervention!

If meniscal injury occurs similtaneously with ACL rupture
A locked knee post injury when fragments of injured tissue get stuck in the joint
When the knee is inherently unstable and continues to give way
If a patient is functionally unable to return the affected knee and lower limb to pre injury status with conservative care
When conservative management fails in successfully returning the athlete or player to sport.

The above actually my MRI post ACL rupture. I also experienced a large lateral meniscal tear and locked knee requiring immediate surgery and ACL reconstruction.

How do I know if surgery or not having surgery is the best outcome for ME following and ACL rupture or tear?

This really is an informed decision that you as a patient must make by:

Weighing up all the Pro’s and Con’s
Understanding (with a highly skilled clinician) the pathology present in the knee post injury
Knowing the function of the knee post injury
Monitoring how well the knee improves with conservative management early on is a good predictor of long term positive outcomes
And ultimately the mindset and wiliest of the patient to over come the injury and put the work in needed to return strength, muscle size, proprioception and confidence in the knee again.

I hope you learned something from this blog.

As you can see I have personally had the pleasure of having an ACL reconstruction myself, but also rehabilitated many conservatively as well.

Maybe you know of some people that have suffered an ACL injury this season and may benefit from some education on this hot topic.

Feel free to share it.

Dean Phelps

Dean is a registered Gold Coast Physiotherapist with undergraduate and postgraduate studies in Human Movement and Exercise Science. His background has developed his vision for Fighting Fit Physiotherapy to focus on optimal health and peak physical performance for every single patient. Utilising his many qualifications, in depth knowledge of the body and passion for exercise he can provide a holistic approach to your treatment and exercise prescription to get the best outcome.

Brenda Samosa

05:52 07 Nov 24

I had a really bad shoulder and had been seeing a different physio for 3 months (from a different place) I got told Tyson was good. After just a few sessions the movement was coming back. I’m 66 and was worried I would have to stop surfing. But with a lot of help from Tyson I’m back in the waves ( thank you so so much)

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Shout out to Max from fighting fit physio. He helped me out massively straight after shoulder surgery and back into work and sports in no time. Couldn’t recommend anyone better!

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I highly recommend this business.

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08:27 14 Jul 24

Be AWARE they’ll immediately try to commit you to multiple follow up sessions after your initial consultation. This happened to me and then I later found out that as it just so happens, they have a cancellation policy that says you have to pay 100% of the consultation fee for cancelling. They failed to tell me this when they were pushy in committing me to 6 sessions after my consult, so that was a really nice little surprise.

I was already uncomfortable with how pushy they were in having me commit to so many sessions, so when I heard about the policy I just cancelled all together. So, I can’t speak further to the quality of their service throughout therapy phase. FYI this was also a few months ago now, it’s possible (though unlikely) they may have changed the policy. Just ask the question.

Megan Shelley

06:51 03 May 24

Fighting Fit Physiotherapy is hands down the best physio I've encountered. Having tried multiple physios for various injuries, I always find myself coming back to them. Their expertise consistently exceeds expectations, helping me get back to my sport faster than I thought possible. Their personalized approach and attention to detail make all the difference. I could not recommend a better or more exceptional physio team!

Gina Matthews

08:41 24 Mar 23

Can't recommend this place high enough. I was in so much pain with my knee an had been for months through advise an exercises I'm now looking forward to returning to gym an back riding my horses in endurance thank you so much

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01:36 29 Nov 22

Kyle was knowledgeable, personable and professional. He saw me through my second pregnancy and continued to work with me until 6 months post partum on issues with my back. Would recommend anyone to go and see him.

Also shout out to Georgia on the front desk. She makes you feel welcome and brings a sense of warmth to the place!

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08:07 04 Nov 22

After hip replacement surgery in February I wanted toget back into weight training legs, I started with Mitch 18 weeks ago and after a lot of hard work and sweat I am able to safely train again, I cannot thank Mitch enough for his support,encouragement and knowledge. The staff are friendly and helpful and I always looked forward to my session's

Robert Parkinson

10:50 15 Aug 22

This is the second time I have been treated by the team at FFP.
As a health professional myself I have been impressed with the level of care I have received from all members of the team.
The personalised treatment and rehabilitation programs have produced excellent results and I have completed both programs pain free and feeling stronger than before my injuries.
During the program there was constant communication and follow up and they were very accommodating with my work schedule.
All in all it was a very holistic experience and I would highly recommend the service.

Kiri Canavan

07:30 08 Jun 22

Tyson was amazing! We came up with an 8 week plan at my first consultation with weekly check ins and updates to exercises. 8 weeks later, I am pain free and able to train harder than ever. Highly recommend and the staff are all fantastic and super accomodating!

The Bias Toward Surgery!

Why is this only just coming out?

For the first time EVER!

The Pro's & Con's LIST!

When may ACL reconstruction be required?

How do I know if surgery or not having surgery is the best outcome for ME following and ACL rupture or tear?

The Desk Worker’s Guide to a Pain-Free Neck

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