ACL Non-Op Rehab

If you’ve recently been diagnosed with an ACL rupture, you may believe surgery is the only plan of care you have available. For a large percentage of individuals who have suffered an ACL tear in the Reno-Sparks area, this may be inaccurate. While we do our best to avoid giving our opinion when it comes to whether or not an individual needs surgery, as this is a deeply personal decision, we are dedicated to educating our patients on what the current research supports and how to make sense of it. Knowing all of your options and being educated is essential for informed consent and Nevada Physical Therapy is your expert in this realm.

A recent study performed by Grindem et al. (2014) investigated outcomes based on specific sport participation and found that whether an individual needed surgery or not was highly dependent on: what sports or activities they were trying to return to, age, history of re-injury and other variables that make the decision to pursue surgery one that you should discuss with your surgeon AND your physical therapist. The Grindem study suggested that if you played Level II or Level III sports (how they decided these levels is a conversation for another time) and found good outcomes for non-surgical management in these cases. Specifically, they found if you are over the age of 30 and have a goal of returning to level II or III sport participation then you may be an ideal candidate for non-surgical rehabilitation. The authors reported that knee function was nearly identical in both groups at 2-years when looking at knee strength, patient subjective reports (IKDC scores-lnk to IKDC post)) and laxity. Specifically they reported 17% of the non-op group had an IKDC score below the 15th percentile compared to 22% in the surgical group, limb symmetry index less than 90% (comparing to the non-injured side) for knee extension and flexion strength was 23% for both parameters in the non-surgical group compared to 34% (extension) and 35% (flexion) in the surgical group. It should be noted that a weakness in this study was the heterogeneity of rehab programs and lack of a standardized plan of care.

A meta-analysis (considered the highest level of research) performed in 2013 by Smith et al. found “limited evidence to suggest superiority between reconstruction versus nonoperative management in the functional outcomes of people following ACL rupture.” However, they do caution that there is limited high quality research comparing the two outcomes so interpreting these results should be done on an individual basis. There are many myths that persist regarding the decision to undergo ACL reconstruction such as additional meniscus damage, increased risk of arthritis, etc. however these ideas seem to be out of date and not supported by more recent research (Ekas et al. 2019, Zadros & Pappas, 2018). You can read more about one of our clinician’s experiences being ACL deficient for more than 20 years and a more detailed investigation into the current research in this blog post.

If you’ve made it this far you likely have far more questions than when you began your research on whether or not ACL surgery is the best choice for you. Alternatively, you may have already decided you do not want to undergo ACL reconstruction and are looking for treatment options. The intent of this content is to help educate the Reno community on the available options and the science behind making these decisions and Nevada Physical Therapy is not only personally and professionally experienced in this realm but we are uniquely trained to help athletes and active individuals get back to enjoying what they love, surgery or not. Choosing a provider that can guide you through this journey can make all the difference.