Orthopedist Questions ACL Injuries

ACL repair

I have heard that isn't necessary to repair a torn ACL, is this true?

32 Answers

It depends on the age and activity level of the individual with the torn ACL. It also depends on whether or not the meniscus is torn as well.
Yes
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Without knowing your age, your X-rays, etc., it is difficult to answer.
ACL reconstruction is not necessary if you aren't experiencing instability of the knee. People who should consider ACL reconstruction are those who want to play sports where there will be frequent running, cutting and pivoting. These activities can predispose you to injuring other structures in the knee if the ACL is not intact. Some people with ACL injuries experience instability while merely changing direction when walking. These patients should probably have the ACL reconstructed as well in order to avoid falls or further injury to the knee. It is also true that some people play sports with a brace as opposed to getting an ACL reconstruction. If a brace provides sufficient support it is also an acceptable alternative to surgery.
An ACL tear always has to be repaired. There are rare exceptions which include all contraindications of surgery in case of severe internal medical conditions which forbid any surgery. Replacing or repairing an ACL is not a life-saving act and thus it is not of vital necessity.
But for proper knee function, the ACL is very important. If you are an active person, who wants to stay active and you feel instable within your knee, you need to fix a torn ACL (different methods and indications) regardless age.
By latest consensus in the AGA (German - Swiss - Austrian Arthroscopy society) conference in Munich 7.-9., September 2017, ACL repair is recommended, if there are no contraindications (diseases which forbid surgery).
Depends on age and activity level, not an emergency. Try non-surgical treatment - brace, physical therapy.
That can be true. It depends upon your symptoms, age, activity level, and expectations. If you're under 40 and have functional instability, meaning your knee gives out with just daily activities, then you should consider having it reconstructed. If you are compensating well with your quads and hamstrings and you don't plan on playing competitive sports, you probably can forgo surgery. Either way, unfortunately, when you tear your ACL, you are 6X more likely to develop arthritis in that knee.
The ACL is a ligament that gives your knee stability. Younger, active people, especially if you perform cutting/pivoting sports, may find it difficult to return to their full activity because they will feel their knee shift or buckle. Less active or older people many times can perform a lot of activities without issues. So not every ACL tear "needs" surgery. If you have instability, or the feeling that your knee buckles or gives way, with everyday activity or sports that is not good for the knee as it may lead to further damage, and your quality of life is affected, then an ACL reconstruction may be an option.
That is true
It depends on several factors. What age you are, What are your physical activity goals, What condition you knee is in. please go to www.MichaelLimMD.com to schedule an appointment and to discuss what your specific goals and needs are.
All knees are different and not all ACL tears need to be repaired. It really depends on activity level and feelings of instability. Degree of arthritis is also very important.
That's true. Most of the time, the ACL is not reparable and must be reconstructed. The demands of a patient's lifestyle or perception of instability of the knee are deciding factors on when to have a reconstruction or not. Athletes engaging in sports such as soccer, basketball or advanced snow skiing usually benefit from surgery. Recreational straight line athletes likely will not benefit as much.

DK
There is no one answer to this question. It depends on your age and your activity level. It also depends on the intrinsic stability of your knee. It depends whether you have strong hamstrings.
In general if you are young and actively participating in sports you should have it repaired if you are older and less active a good rehab program should be sufficient.

Whether it's repaired or not rehab is the key. If you talk to professional strength coaches who have the longest follow up treating in dealing with patients with ACL repairs they say that the best result are with cadaver bone tendon and bone ACL. They cautioned against using the hamstring for repair even though many surgeons favor this technique. I guess the surgeons are listening to the people who follow the patients the longest
The choice to repair a torn ACL is dependent on several factors. First, most ACLs are reconstructed and not repaired, however, there is a new trend and increased success lately with repair of the partially torn ACL or with repair in the very young population that may still have growth plates still open. As for most patients, it is recommended to reconstruct the ACL to prevent the development of future meniscal injuries and arthritis. The ACL helps provide stability to the knee in a few directions and thus helps protect the meniscus and cartilage and helps patients get back to activities. In my practice, one of the few reasons to choose not to reconstruct or repair an ACL would be if a patient already has significant osteoarthritis. If the patient already has significant osteoarthritis and is a candidate for a total knee replacement, then it would be acceptable to not fix the ACL and just do a knee replacement when the pain or instability is sufficient enough to warrant it. This incident will most likely be in the older population. Some will argue that with physical therapy and bracing you can avoid ACL surgery and compensate for a torn ACL. I will argue that very few patients who choose this route actually return to their previously level of activity or their previous knee satisfaction. In general, my recommendation is to reconstruct or repair ACLs unless the patient is not healthy enough to do so, or already has too advanced degree of arthritis.
The decision for surgery after an ACL tear depends on the degree of subjective instability, the patient's level of activity and plans for future activity. Surgery is certainly not required for an isolated ACL tear. If the patient is a competitive athlete involved in curry sports such as Soccer Basketball etc, they would most likely want the ACL reconstructed.
Although there are some positive reports out of Boston in younger patients, we don't truly "repair" an ACL tear. What we do is reconstruct the ligament using other tissue.

There are many variables when it comes to deciding if a patient should undergo ACL reconstruction. These include age, activity status, concurrent cartilage tears, and feelings of instability with activities of daily living, work, and leisure activities.

In general, I recommend ACL reconstruction for teens(sometimes younger) through age 40. After 40, if the patient is very active in pivot sports or has instability I would recommend repair. The ACL is a protective ligament for the meniscus cartilage and provides stability to the knee. As our life expectancy continues to climb, I expect ACL reconstruction to be recommended, routinely, for those over 40.
The recommendation to repair an ACL is usually related to knee stability.
Most patients benefit from having ACL surgery if they suffer a complete tear. The reason would be giving way of the knee that leads to cartilage damage and potential future arthritis . If there are no issues with stability or locking or swelling, then brace with physical therapy can be attempted. The younger the patient, the more we would advocate for surgery.
Not every person with ACL tear requires surgery. I recommend surgery in every person up to 40 years and those with unstable knee joint after 40 years.
It is true that if you are prepared to modify your lifestyle and avoid sports which cause a twisting strain to the knee, you may have enough stability in the knee to allow normal daily activities without needing to have the ACL reconstructed.
This answer really depends on the patient. If the patient is not very active and does not do many activities that require fast change in direction, then having acl reconstruction is not always necessary. I recommend anyone who has an acl injury to see an Ortho knee specialist and develop a treatment plan with the doctor.
This is true, but the answer depends on the patient's situation. The anterior cruciate ligament (ACL) is the main stabilizer for the knee joint. The ACL keeps the femur and the tibia aligned which allows the knee to flex and extend. Without the ACL, the femur will slide on the tibia and cause a shearing force across the cartilage. This shear can lead to rapid degeneration of the cartilage and possibly the early need for a knee replacement.
So, if you don't intend to use the knee very much, the ACL will not be used very much and the cartilage will not degrade as quickly. Those that want to participate in athletics will definitely need an ACL. In those patients that already have severe degeneration in the knee cartilage (arthritis), the ACL does not need to be repaired because the patient actually needs a knee replacement.
Repairing an ACL tear will not work , the only way to stabilize the knee is to replace the ACL with a new tendon graft !
That depends on several factors. A few aspects of this are as follows: patient age, degree or percentage of tear, level of arthritis, patient activity level, other tears / injury, etc. Regardless, I would recommend having an ACL tear evaluated by an orthopaedic surgeon so the appropriate treatment can be started.
This is a very interesting and somewhat complicated question. There is neither a simple yes nor a simple no answer. There are a number of factors to consider when attempting to answer this question.

First is the person's activity level. The vast majority of people who want to participate or compete in cutting sports (soccer, basketball, football, baseball, tennis, etc.) need intact ACLs for knee stability and proprioception in making change of direction maneuvers. A very small proportion of the population has the neuromuscular development and coordination to make such maneuvers without the knee and limb control provided by an intact ACL.

Second is the instability in the knee. Some people who have no interest in participating in sports experience such a degree of instability in normal daily activities that they require ACL surgery to function. One of my professors experienced such a level of instability simply walking around his clinic that he underwent ACL surgery in his 40s just to be able to get through his work day.

The condition of the posterior horn of the medial meniscus is also a consideration. If the meniscus is intact, it acts as a secondary stabilizer against knee instability to the ACL and can act to provide stability when the ACL is absent. If a person has neither an ACL nor a medial meniscus, then the knee is usually very unstable and requires surgery.

Finally, one must consider the long term effects of ACL deficiency in the knee. Repeated episodes of pivot shifting or instability will damage the joint surface cartilage, leading to arthritis in the long term. ACL deficiency will put additional stress on the medial meniscus, leading potentially to meniscus tears and then cartilage damage and arthritis.

Thank you for your interesting question.

Kenneth R. Brooks, M.D.
Whether or not you need to address an ACL tear surgically depends on many factors, but the most important are your age and activity levels. The younger and more active you are in cutting sports (i.e.--football, lacrosse, basketball, skiing, etc), the more likely you will need surgery. If you are less active, older, and willing to modify your lifestyle, you can attempt a trial of non-surgical management with physical therapy and bracing. If your knee remains or feels unstable and affects your ability to maintain your desired lifestyle, you can always consider surgery at a later time.
While ACL reconstructions are very popular, the truth is that the incidence of arthritis has not been shown to decrease in those who undergo the surgery compared to those who don't. It is felt by most surgeons that the time to onset of degenerative changes may be delayed by reconstruction and there is solid evidence that individuals who have ACL tears have a dramatically increased risk of sustaining a major meniscal tear within 5 years, if the instability isn't corrected. There is very good evidence that the loss of a majority of a meniscus is devastating to a knee joint, therefore; most of us feel the symptomatic ACT deficient knee is probably better off being stabilized surgically than not, especially in a younger patient.
If you have torn your ACL and are reasonably active, you will most likely experience instability episodes with twisting, pivoting, jumping, cutting activities. Each episode could cause a tear in your meniscus or damage your cartilage and place you at risk for developing arthritis.
If you have a torn ACL + meniscus tear, then you should have surgery to address both. If you have an isolated ACL tear and don't participate in activities noted above, then you could try to get by without surgery, but if you experience instability, then should have surgery.
Also, about 30% of ACL tears are eligible for primary ACL repair, where your own ACL is repaired, instead of a traditional reconstruction in which your ACL is replaced with a graft. A handful of surgeons in the U.S. currently perform primary ACL repair.


Vic Goradia, MD
Knee, Shoulder and Sports Medicine Specialist
That is partially true. It depends upon your activity level and whether or not you have symptoms of instability. Some people can get by with a special brace, usually they limit some of their activities. Some people give up vigorous activities. I would say most young, active patients elect to have surgery because they want to stay active. It is an elective surgery. It also depends if you have other injuries associated with it, like torn meniscus or MCL. With other pathology, the knee is more likely to be unstable.
DR Baier
Not all knees with torn ACL require/need reconstruction. It all depends up how this ACL deficient knee is troubling you. If it is giving way and affecting you in your day-to-day life, work and social life, ACL reconstruction is the answer.
Requires a trial of conservative care unless a professional athlete.
If the patient is older (>50). inactive and the knee isn't giving out, then its okay to not repair. However, chance of arthritis goes up. Younger, more active patients usually require repair.

Bose