ACL Tear Treatment Outcomes: To Have Surgery or Not Have Surgery



An ACL tear does not necessarily mean surgery. A recent study found that surgical and nonsurgical treatment for ACL tears have about the same outcomes at a two year follow-up. The study took 143 participants with ACL tears less than three months old and followed them through their treatment over a two year period. They measured initial strength and functional capabilities, then had them participate in a five week rehabilitation program emphasizing strength. Participants were then counseled on recommended treatment–surgical or non-surgical. Of this group, 100 went ahead with the surgery and 43 opted to not have surgery. The decision to have surgery hinged on the additional tear of the medial meniscus, the desire to return to a pivoting type sport (such as soccer or basketball), as well as incidences of “giving out” of the knee. The non-surgical group had an additional two to three months of rehabilitation. Following surgery, the surgical group had six to 12 months of rehabilitation consisting of strengthening, plyometrics, and neuromuscular training.

Overall, there were no significant differences between the two groups at the two-year follow up, with the majority of both groups reporting significant improvements in their self-reported knee function and having comparable strength. Of the entire participant population one-fifth did have knee re-injury and one-third had muscle strength deficits, neither of which were correlated with either treatment option. These results must be interpreted with caution however, because the surgical group was significantly younger and more likely to be participating in pivoting type sports than the non-surgical group.