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. It works by preventing forward slippage of your shin bone under your knee. It also resists rotational forces to your knee joint. ACL tears are a common sports-related injury, and they often require 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 or pivoting maneuvers, such as soccer, basketball, or football.

But does everyone who tears their ACL need surgery, and can your anterior cruciate ligament heal on its own once it has been torn?

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. 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. Rehab after an ACL reconstruction typically takes three to six months to return to full function. You may think the injury is not as severe as initially feared, and that perhaps it can heal with non-surgical treatment.

In the past, it was thought that a completely torn ACL has no chance of healing thoroughly. However, recent research has shown that occasionally the ACL can spontaneously heal over time, allowing the patient to return to high-level functioning with no knee instability. While not everyone needs a functional ACL to perform their day-to-day or preferred activities, athletes who participate in certain sports that require pivoting maneuvers do require a fully functioning ACL. Typically, the ACL is repaired surgically. But it may also heal spontaneously over time.

Currently, there is no clinical prediction rule to figure out which patients will experience spontaneous healing and which will require surgical repair. Research indicates that some patients with spontaneous healing of the ACL experience a re-tear at a future time. That said, some patients with an ACL repair also experience re-injury to the ligament.

A Word From Verywell

After an ACL tear, your knee may begin to feel much better, but the decision for the next step in treatment should be based on other factors than how the knee feels. The more important considerations are the examination findings, the MRI results, and your personal goals. Some people may choose to wait and see if the ACL heals, while others will want to quickly get into surgery to begin the ACL rehab process. It appears that non-surgical management certainly has a role in ACL treatment, so the decision to operate or not should be multi-factorial. A discussion with your surgeon regarding your expectations of treatment may be the best course of action.

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