Do you have to get surgery after you tear your ACL? Nope. You have options!
Once you have confirmed your anterior cruciate ligament tear, you have multiple treatment options:
- Cross bracing protocol
- 3-6 months of supervised, progressive rehabilitation
- Surgical option – undergoing an ACL reconstruction
- Non-surgical option – continue with rehabilitation management
- Delayed surgical management – deciding to have surgery after completing a course of rehabilitation
Research has confirmed the ability of the ACL to have the capacity to heal, so the trial of rehabilitation should be first-choice for most athletes to see if they can cope and function without requiring surgery.
Non-surgical management
Camille Santiago is a friend of mine who injured her knee almost a year ago. She shares her experience with her injury and current rehabilitation management plan.
How did you injure your ACL? And how many months post-injury are you now?
Camille: Skiing; 10 months post-injury
What brought you to this point in your rehab?
Camille: After many months of physio, consulting multiple health care professionals, getting an MRI, as well as getting both manual testing of the knee joint and performance testing throughout my rehab/recovery, I decided to go the non-surgical route.
My knee was feeling really strong and stable, I didn’t have any episodes where it buckled or dislocated, and was progressing in my exercises at a more advanced rate than what was initially expected.
Run us through the type of rehab process you’ve been through up to this point.
Camille: Initially, physio exercises twice a day every day; tapered this to 4 days a week. Eventually dropped normal physio when I progressed to more advanced weight training exercises on top of returning to some regular sports such as hiking/light running/climbing (wearing my custom ACL brace).
What are your main sports that you have been missing out on during your rehab?
Camille: Climbing, hiking hard/long distances, and for this upcoming winter season, I will be saying no to downhill skiing but will return to cross-country skiing whilst wearing my knee brace.
How long after your ACL injury did you return to your sport? Are there things you are not doing at this point due to your ACL injury?
Camille: Approximately 2 months post-injury I was able to return to a light hike, whilst wearing a brace. I started returning to climbing 4 months post-injury, but only traversing and staying low to the wall, climbing well below my grade to ensure I don’t fall and twist my knee/cause further injury. Still not really climbing or hiking regularly but this is also in part due to being much busier than normal with work.
In terms of confidence, how did you feel about your knee and your ability heading back to your sport?
Camille: I would say I have a medium level of confidence. I have started feeling more confident bouldering with my ACL brace but I still don’t like taking risks where I feel like I will fall from a height. I have zero confidence returning to skiing at this stage, but maybe next year!
Are there certain aspects of the injury and rehab process that were unexpected?
Camille: It was so unexpected for me to be able to return to sports and have a mostly functional knee within as little as 3 months. I do feel like I got a bit burnt out trying to manage physio/weight training/doing sports “for fun” plus work and summer activities, so I definitely slacked on my weight training over the last couple of months. Looking forward to returning to a more diligent routine over the winter.
For someone going through an ACL injury, particularly the non-surgical route, is there anything specific you’d want to share from your experience?
Camille: A diligent physio routine from the start really helped, but every case is so different and nuanced and I think ultimately it’s about listening to your body and knowing what your limit is, as well as your own tolerance for pain/discomfort/risk.
I was lucky that my knee didn’t buckle or feel unstable, and this may be due to my own joint morphology in addition to the physio routine.
I think balancing what you are realistically able to accomplish within your own life/day-to-day schedule and advocating for yourself is also really important—there’s no point lying to yourself/physio/trainer and telling them you can commit to 90 minutes a day, 4 days a week, when you can’t, but there is definitely a way to do it so that you’re still staying disciplined and managing the rest of your life around your injury.
Similarly, you don’t have to do surgery just because the surgeon said so—explore your options and get second opinions from trusted professionals/sources!
What does the next 6 months look like in terms of your rehab and plan?
Camille: Returning back to weight training 3 times a week as well as returning to the winter adult climbing program in my local gym! Looking forward to regaining my strength and pushing myself.
Key Takeaways:
Camille touches on a few really important aspects of ACL injuries:
Consulting healthcare professionals
- Your injury is unique and not all ACL injuries will be managed the same. Having concomitant injuries like MCL tears, boney injuries or meniscal injuries may influence your treatment options.
Re-gaining confidence
- Having confidence in your knee usually comes from gradual re-entry to acitivity after having progressive rehab exercises and performance testing completed.
Taking breaks during your rehab
- Trying to do it all is a lot – burn out in rehab can absolutely happen and is difficult to manage. Most of us who go through ACL injuries are not elite athletes, so we also have to deal with organizing the rest of our lives – with this in mind, the rehab process might take a little longer, which is normal. I wrote some tips on managing the process.
The ACL can heal
- The ACL can heal! And even if it doesn’t completely heal, athletes can still return to high level sports and function without surgery so non-surgical management is a very viable option and should be explored.
Completing phased rehabilitation
- Returning to sport in most capacities will require progressive, phased rehabilitation. This can help to reduce injury risk in the future and determine if you will be a ‘coper’ (not requiring ACL reconstructive surgery).
To learn more about ACL injuries and treatment options, I’d recommend the ACL Injuries ebook.
