Surgical vs non surgical ACL injury management:
As part 1 of our ACL series explained, the stability loss at the knee when an ACL is ruptured is devastating. For the most part this is due to the time it takes to rehabilitate and restore knee function. Differing ACL injury management pathways have been more widely considered recently due to emerging evidence for each.
In short, the ACL can be reconstructed through a surgical procedure, or healing can be assessed overtime non-surgically.
In surgery, an ACL graft is taken either from the injured patient themselves (there are a few graft site options), or a donor graft. Non-surgically, there are bracing and rehabilitation strategies that look to promote healing of the injured ACL, or build sufficient stability through the surrounding structures to achieve the desired rehab goals without the requirement for surgery.
Essentially, the management protocol must be a team decision involving the orthopaedic specialist, the client, the treating clinician and other relevant health care specialists. There are a number of factors relevant for each client that must be considered:
- The degree of the injury
- The resultant level of instability at the knee
- Associated injuries to the meniscus and / or other ligaments
- Individual goals
- The functional demand of the desired sport
The Role of prehab:
If surgical management has been selected.
The time between ACL injury and surgery is very important. Evidence shows the better condition of the knee before the operation, the better success post surgery.
A clear and direct focus helps to shift this period away from the risk of de-conditioning and losing confidence, to a time of education, preparation and improvement. Progress through this phase will alway progress in parallel with the condition of the injured knee but should be active, aiming to gain symmetry, and ensuring the client becomes familiar and comfortable with the set of exercises that will commence after the surgery.
We tend to divide the focus of goals into two main areas:
Recovery from the knee trauma:
- Eliminate knee swelling
- Restore full knee extension
- Achieve a comfortable, symmetrical gait pattern
- Eliminate the risk of further injury to the knee
Prepare for the surgical procedure:
- Prevent the extent of muscle inhibition
- Avoid poor learned movement habits
- Promote strengthening and limb symmetry of muscle strength
- Familiarisation with the post-operative exercise
We also use this time to take baseline information that will assist us to determine readiness to return to activity and sport in the future.
Finally, there are surgical and non-surgical ACL injury management options. Consequently, The decision should be made by the treating team including orthopaedic specialist, the client, the treating clinician and other relevant health care specialists. Evidently each situation should be considered individually, and the time spent between injury and a planned surgery is vital to improve overall outcomes.