Determining the Need for Surgery When You Feel Better Post-ACL Tear

man with knee pain
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The anterior cruciate ligament (ACL) is one of four major knee ligaments. ACL tears are a common sports-related injury, and often requires surgical reconstruction. Without surgery, athletes with an ACL tear may have recurring problems with knee instability. Athletes who have a torn ACL often experience symptoms of buckling or giving-way of the knee joint, especially when playing sports that require cutting of pivoting maneuvers such as soccer, basketball, or football.

The Injury and Recovery Process

After an ACL tear, the knee is usually swollen and painful. Patients who sustain this injury are uncomfortable and know they have a serious problem with the knee joint. The pain is often immediate, and many athletes can remember hearing a pop that occurs when their knee gives out and the ligament tears. The swelling typically occurs quickly, usually within a few hours, as the knee fills up with blood from the injury to the torn ligament.

These patients are often seen by their physician, who diagnoses the ACL injury, and helps to treat the acute symptoms. Once the swelling improves, and the pain subsides, patients may begin to feel much better. The pain of the initial injury subsides, the swelling of the joint begins to come down, and the knee begins to feel more normal. As mobility improves, many patients begin walking more normally, and may even be tempted to try to return to sports activities.

Factors to Consider

Patients who sustain an ACL tear and then start to feel much better often wonder if they still need surgical reconstruction of the ligament. It can be hard to accept the rehabilitation needed after ACL surgery if the knee starts to feel good again. People often wonder if perhaps the injury is not as severe as initially feared, and perhaps can heal with non-surgical treatment.

Unfortunately, if the ACL is completely torn, there is no chance of the ligament healing properly. While not everyone needs a functional ACL to perform their preferred activities, athletes who participate in certain sports that require pivoting maneuvers are unlikely to be able to return without a properly functioning ACL.

So, while the knee may begin to feel much better, the decision for the next step in treatment should be based on other factors than how the knee feels. The more important consideration are the examination findings, the MRI results, and a discussion with your surgeon regarding your expectations of treatment. While non-surgical treatment certainly has a role in ACL treatment, the fact that the knee begin to feel better should not factor into that decision-making process.

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Article Sources

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  4. Wilk KE, Macrina LC, Cain EL, et al. Recent advances in the rehabilitation of anterior cruciate ligament injuries. Journal of Orthopaedic & Sports Physical Therapy. 2012;(42)3; 153-171.

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