ACL Tear Treatment Options

Nonoperative treatment involves:

• PRICE: protection with bracing, rest, icing, compression, and elevation to reduce pain and swelling
• Pain management with over-the-counter anti-inflammatory and pain medications (NSAIDS)
• Non-weight bearing, using crutches
• Activity modification
• A comprehensive rehabilitation program to strengthen and stabilize the knee. Rehabilitation is also valuable to prepare the patient for surgery by improving strength, coordination and mobility.

Nonsurgical treatment is an option for patients with physically low-demand lifestyles and those who do not intend to return to pivoting sports. For recreational athletes with an ACL tear, initial treatment may be nonoperative with physical therapy or surgery with rehabilitation.

Older patients who desire to return to high-functioning athletic activities may be good candidates for surgical reconstruction which can provide good knee stability and good functional outcomes. Importantly, studies report that the outcomes of ACL reconstruction in older athletes are similar to those in younger patients.

About 50% of patients who choose nonsurgical treatment later choose surgery. Moreover, studies report that nonoperative treatment of ACL injuries failed in 60% of patients who were young or participated in high impact sports.

ACL reconstruction is the gold standard treatment to replace a torn ACL. About 130,000 arthroscopic ACL reconstructions are performed annually. Most are performed on an outpatient basis and with success rates as high as 95%.

Most young, active patients elect to proceed with surgical reconstruction because nonsurgical treatment is associated with an unacceptably high risk of recurrent instability, secondary tears of the meniscus, osteoarthritis and the risk of need for a future total knee replacement.

• young adult athletes who desire to return to sport
• patients with more than one injured ligament
• patients who also have a torn meniscus. 50% of ACL tears occur with a torn meniscus
• patients whose instability remains after nonsurgical treatment

Dr. Petrigliano may recommend reconstruction to reduce the risk of injury to the cartilage and meniscus, and to facilitate a return to sport and activities. Successful post-operative rehabilitation is essential to recovery.

Timing of ACL reconstruction depends on multiple factors. Importantly, restoration of knee range of motion and quadriceps control are important goals before ACL reconstruction regardless of age. The advantages of early ACL reconstruction include shorter time from injury to surgery which reduces the risk of scarring, and potential reduction in meniscal injuries.

Whether to pursue surgical treatment depends on the type and severity of the injury, the patient’s age, activity level preinjury, occupation, functional status and associated injuries, if any. Young and active patients usually choose operative treatment to return to play. However, patients with significant knee instability or damage to multiple knee structures may opt for surgical reconstruction.

ACL reconstruction surgery is minimally invasive arthroscopic surgery that involves the use of a tissue graft to replace the damaged ACL. The graft may be retrieved from another part of the patient’s body (autograft) or donor tendon (allograft). The damaged ACL is removed and replaced with the graft. The graft is secured to the bones with screws and other devices.

The key to successful reconstruction is the ability of the graft to integrate into the bone.

To facilitate the growth of new tissue, Dr. Petrigliano may employ biological augmentation a regenerative technique to enhance healing and improve outcomes.

Return to play or full activity is estimated to take 6-12 months after reconstruction with significant progress in physical therapy and the type of sport being important factors. Early return to activity creates a risk of re-injury and graft failure.