The anterior cruciate ligament (ACL) is one of the key ligaments in the center of the knee that help stabilize your knee joint. Dr. Cunningham explains that “ACL injuries are most commonly seen in younger athletes participating in cutting and pivoting sports.” ACL tears typically occur during sports that involve sudden stops, jumps, or changes in direction such as skiing or soccer. ACL injuries less commonly occur as a result of contact during sports, such as when colliding with another athlete. Most ACL tear in the middle or midsubstance of the ligament. ACL tears less commonly tear where they attach to either the femur or tibia bone.
Will ACL Heal Without Surgery?
A question patients commonly ask Dr. Cunningham is, “Will my ACL tear heal without surgery?” Partial ACL tears can heal without surgery, however, partial ACL tears are uncommon. In partial thickness tears, where, for example, 30-40% of the ligament fibers are torn, but 60-70% of the ligament fibers are intact, these tears can heal. Dr. Cunningham can identify if an ACL tear is partial thickness based on how lax the ACL is on physical exam and also on MRI findings. Furthermore, ACL tears where the ligament does not tear in its midsubstance but rather peels away from its bone attachment can also heal, but these types of tears are quite uncommon.
Most ACL tears are full thickness, midsubstance tears where the ligament tears completely and these do not heal on their own. Complete ACL tears do not heal because the torn fibers are bathed in fluid filled environment in the knee joint. In this fluid filled environment, normal clotting and growth factors cannot organize themselves and knit the torn ends of the ligament back together. Non-surgical treatment options, like physical therapy, can help strengthen the surrounding muscles and improve the knee after an ACL tear, but PT does not typically restore knee stability in athletes.
When ACL Surgery Is Necessary
Dr. Cunningham notes, “If there is a complete, midsubstance ACL tear in a younger athlete who is experiencing instability and who wants to return to cutting and pivoting sports, surgery is usually recommended to restore knee stability, function, and prevent further damage to the knee.”
Factors Influencing Surgery Timing
Several factors can influence the timing of ACL surgery. Dr. Cunningham highlights, “the patient’s age, activity level, and the presence of any associated injuries – such as meniscus tears – play a significant role in the decision-making process.” Typically, one’s knee is very swollen and stiff after tearing one’s ACL. Given this, Dr. Cunningham often prescribes a few visits of physical therapy in order to restore good knee range of motion and decrease the swelling before undertaking surgery. If an athlete is older, Dr. Cunningham usually recommends against immediate ACL surgery and instead recommends they try a course of physical therapy and then a gradual return to their sports and activities in order to determine whether the knee is persistently unstable or not. Many older athletes can avoid ACL surgery and return to their activities as our knee joints becomes naturally stiffer as we age and therefore an older athlete may not experience recurrent knee instability that would necessitate ACL surgery. However, if upon returning to activities, one’s knee is chronically giving out and giving way, then usually ACL surgery may be necessary.
Potential Risks of Delaying ACL Surgery
While immediate ACL surgery isn’t necessary, delaying ACL surgery can have its risks. “One of the main concerns with delaying surgery is the potential for additional damage to the knee, especially tearing of the meniscus,” Dr. Cunningham cautions. “Without a stable ACL, patients will most likely experience further giving way episodes to the knee and these excessive shear forces usually result in tearing of the meniscus or articular cartilage, which can lead to early-onset arthritis.”
Choosing the Right Surgical Approach
For those considering surgery, choosing which ACL surgery is best is a critical decision. Dr. Cunningham emphasizes, “The type of surgery, whether it’s reconstruction with an autograft or allograft, or possibly a primary ACL repair, the treatment plan should be tailored to the patient’s specific needs and goals. Our aim is to provide the most effective treatment to ensure a safe and successful return to their sport.”
Recovery and Rehabilitation
Post-surgery, a comprehensive rehabilitation plan is essential. Dr. Cunningham states, “Rehabilitation is crucial for regaining strength and mobility. It’s a gradual process that requires patience and adherence to the prescribed therapy regimen.”
Top ACL Doctor in Colorado – Richard Cunningham, MD
Deciding if or when ACL surgery is necessary can be complex and depends on individual circumstances. While some patients may be able to compensate with non-surgical treatments, others, especially athletes, may require ACL surgery to regain full function and return to their sport. Dr. Cunningham’s expertise and holistic approach ensure that each patient receives personalized care tailored to their unique situation.
For those wondering, “Will ACL heal without surgery?” and “Which ACL surgery is best for athletes?” Dr. Cunningham’s advice remains invaluable. By consulting with an experienced sports medicine trained orthopedic surgeon, patients can make informed decisions that best support their long-term knee health and athletic goals.
Contact Dr. Cunningham and his team today to learn more about ACL injury management and to ensure you receive the best care possible for your knee health.