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Ruptured ACL, what are my options? 

 

This is a difficult question to answer and one that has been raised increasingly often by patients in our clinics over recent years. There is a growing body of evidence comparing both surgical and non-surgical options, highlighted by high profile athletes such as Tiger Woods who won 5 out of 6 tournaments before having surgical repair and some case studies on Premier League players who are currently playing without an ACL after an 8 intensive week rehab protocol (Weiler et al, 2015). 

 

Non-surgical 

 

An important aspect in all of this is whether you have an unstable knee, meaning does it give way. If it does give way, and you decide to ‘wait and see’ or for complete non-surgical well then you increase your risk of meniscus tear. This is thought to be associated with the early onset of arthritis, especially in the young adult (Roos, 2005). However, the evidence is mixed. Moksnes et al (2013) would suggest there is no difference between surgical and non-surgical in a 5-year follow up. We probably need a longer follow up times here before we can reach a conclusive decision. 

 

Surgical 

 

For those who opt for surgery, there are a few things to keep in mind. There are risks such as deep vein thrombosis (DVT), infection, graft failure. It is also important to remember and this is something that isn’t as well known; only 63% of surgical patients return to pre-injury level and 44% return to competitive sport (Arden et al, 2011). Fear of re-injury is seen as one of the most common reason for this low number (Flanigan et al, 2013). 

 

So what should you do? 

 

Answering this is difficult and is individual to each case, however we would recommend following the advice provided by the BOA Blue Book for ACL injuries which states: 

“Reconstruction is indicated in ACL Deficient patients with symptomatic instability or a desire to compete in high risk activities” 

In simple terms, if you encounter regular giving way or instability and you wish to return to sport that involves pivoting at speed, surgery is recommended. If you don’t have an unstable knee, comprehensive rehabilitation, guided by a Sports Physiotherapist is a good option. 

We hope this helps with your understanding. If you have any queries, please do not hesitate to get in contact.  

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References:

ARDERN, C. L., WEBSTER, K. E., TAYLOR, N. F. & FELLER, J. A. 2011. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med, 45, 596-606. 

BOA Blue Book http://www.boa.ac.uk/publications/documents/boa_cruciate_blue_book_2009.pdf 

FLANIGAN, D. C., EVERHART, J. S., PEDROZA, A., SMITH, T. & KAEDING, C. C. 2013. Fear of reinjury (kinesiophobia) and persistent knee symptoms are common factors for lack of return to sport after anterior cruciate ligament reconstruction. Arthroscopy, 29, 1322-9. 

MOKSNES, H., ENGEBRETSEN, L. & RISBERG, M. A. 2013. Prevalence and Incidence of New Meniscus and Cartilage Injuries After a Nonoperative Treatment Algorithm for ACL Tears in Skeletally Immature Children: A Prospective MRI Study. Am J Sports Med, 41, 1771-9. 

ROOS, E. M. 2005. Joint injury causes knee osteoarthritis in young adults. Curr Opin Rheumatol, 17, 195-200. 

Weiler, W. Monte-Colombo, M. Mitchell, A. Haddad, F.. (2015). Non-operative management of a complete anterior cruciate ligament injury in an English Premier League football player with return to play in less than 8 weeks: applying common sense in the absence of . BMJ. 11 (2), p1-6 

Very knowledgeable physio Team! Was in London on a business meeting and ended up visiting James for some urgent treatment on my lower back. Delighted with the service. James put me at ease straight away. His treatment was paramount in getting me through what was a hectic weekend. Could not recommend enough. Will definitely be back when in London again!
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Funky Inflatable Co.
17:29 11 Sep 18
Went to "Flawless Physio" two weeks ago for back pain that I'd been carrying for months. Three sessions later, it's all gone! The staff was very pleasant, professional and gave me a series of simple exercises to do at home. I definitely recommend them. I'll be back, hopefully not too soon ;)
Charles Muzard
Charles Muzard
13:04 24 Sep 18
I was recommended to see James by my consultant following surgery to my ankle. He was extremely professional and knowledgable. He motivated me throughout the process and I have now returned to long distance running thanks to his help. I would recommend his services to anyone
David Burns
David Burns
19:32 08 Sep 18
Awesome team. I ended up having to seek out treatment when my back went into spasm (on going problem) whilst down visiting friends. I saw James and he was very professional and through with his treatment. More importantly he gave me a better understanding about what was going on and how to manage my injury in the future. Highly recommended!
James Tatham
James Tatham
08:03 20 Sep 18
I received treatment from Vicky for a very stiff and painful neck, possibly brought on by tension. I felt confident that my therapist was knowledgeable. The service was very friendly and professional and I felt good progress from the first session already. Vicky recommended some exercises and explained how to do them with very clear diagrams and instructions. I would highly recommend Vicky
Tiziana Guffanti
Tiziana Guffanti
17:23 29 Aug 18
I would highly recommend Flawless Physio. Excellent knowledge/treatment and also brilliant customer care - following up and giving advice. Tailored rehab to suit the type and level of sport as well as lifestyle. My wife & I have been treated by both James & Victoria and they have both been great. Will continue to use for any future injury & rehab.
Joe Gomes
Joe Gomes
19:11 30 Mar 19
I saw Victoria for my dodgy shoulder, and she was brilliant. Very professional And knowledgeable, she really took time to explain what was going on and to treat it. She followed up with me to check I was getting on well with the exercises. She is also really accommodating with timings for appointments. I couldn't recommend more highly, thank you Victoria!
Fiona Hall
Fiona Hall
08:35 27 Mar 19
First class. Had 4 or 5 appointments with Victoria that were always late in the evening, although you wouldn't know it. She took her time, whether that be on soft tissue work, explaining how to do an exercise, or the purpose behind it. A genuine person that wants to help and she clearly knows her stuff.
Jamie Moles
Jamie Moles
21:14 20 Jan 19
Went to flawless physio and vic was great! Training for a marathon and she was very understanding and helpful. Living in the Twickenham area so was in great location! Her specialist knowledge in knee injuries was able to get me back running in two weeks 🏃🏼‍♀️
Ruth Herlihy
Ruth Herlihy
23:44 25 Jan 19
I injured my leg (ITB) training for the Berlin Marathon and then made it far worse it by trying to run it. Victoria has been essential in my recovery, helping me understand how to strengthen the right muscle groups and get back to running. I have been very impressed by the depth of knowledge and insight. This weekend I will run the Cancer Research 10km. Thank you!
Paul Carpenter
Paul Carpenter
17:02 28 Jan 19
Really impressed with the service provided at Flawless Physio. Vicky was knowledgeable, professional and her invaluable treatment and advice got me to the start of this year’s marathon when I’d had to stop running with 8weeks to go. Without the advice and care I received at Flawless Physio, at best I’d have limped my way round the course and at worst, not been able to take part at all. Definitely recommend!
Katy Gomes
Katy Gomes
11:03 30 May 19
James helped resolve a hamstring injury that had troubled me for the best part of a year. I'll certainly use Flawless Physio for any future issues. Highly recommended.
Sandeep C
Sandeep C
18:02 30 Apr 19