Question: What treatment options do I have for an anterior cruciate ligament (ACL) injury, and is it always surgery?
Answer: Surgery for ACL tears has come a long way in the last 15 to 20 years, and today is probably one of the most successful and reliable surgeries that we have available to us. However, it's not the only way we have of treating ACL tears and a lot of that depends on your particular lifestyle and what demands you have or are going to place on your knee in the future.
So, we used to be fairly age discriminating when it came to ACL surgery and we'd only do them in young people. Nowadays, we have patients well into their 50s and 60s who are still active and participating in demanding sports such as basketball, skiing, soccer, etc. So, it really depends not on your age but more so on your lifestyle and what your athletic goals are in the future -- what you want to do with that knee.
Again, for those patients involved in high-demand sports that require a lot of stopping, starting, changing direction, etc. -- in other words, demand a stable knee -- those patients most likely are going to be unhappy with an ACL-deficient or a torn ACL in their knee, and those are the patients who are going to be best served by having that ligament repaired or reconstructed with surgery.
The patients who do well with nonsurgical treatment -- and we're talking about physical therapy to rehabilitate the knee to strengthen the knee and try to compensate for the torn ACL as well as being fit with an ACL-specific brace, a custom-fit brace for an ACL tear -- those patients tend to be the patients who are less demanding on their knees, who are involved in lower-level sports, such as tennis or golf, swimming, biking, etc. -- a number of sports that you can do even with a torn ACL, and of course, with a brace and some rehabilitation, can participate at your previous level.
So it depends a lot on your particular lifestyle and demands on your knee, but in general, for the active population, the people who tend to tear their ACLs those are the patients who oftentimes are best served by having the ligament surgically reconstructed.