ACL ruptures – an exploration of your options!

The anterior cruciate ligament (ACL) injury is an incredibly common one through many of our much-loved Australian sports. AFL, soccer, basketball, netball and field hockey are just some of the common sports that can result in ACL rupture. But after the injury has occurred, there are options available to you to, to allow for a successful return to sport or your chosen activity:

  1. Non-surgical management
    This option has historically been ignored, and in Melbourne, we repair more ACLs than anywhere in the world per-capita. However, there is more and more high quality research emerging that ACLs can not only be managed non-surgically, but can also repair in certain people. Non-surgical management means regular and diligent rehabilitation working closely with your physio to guide and progress your strength. The focus of this option is to strengthen the muscles surrounding and crossing the knee – namely the quads, hamstrings, calves and glutes. This “external” support (as opposed to “internal” support from the ACL) can act as dynamic stability for the knee and give extremely high levels of strength for the knee, despite a lack of ligament support. There is also research emerging to suggest the ACL can completely repair itself and long after a person has returned to their chosen sport. This option requires commitment, diligence and a strong work ethic to improve strength around the knee, but saves the need for any surgical procedures.
  2. Surgical option A – hamstring graft
    To replace the torn ACL, an orthopaedic surgeon will take a graft either from the athlete themselves, or a donor. Commonly, this is a part of the hamstring muscle of the same injured leg. The surgeon will remove a section of the hamstring tendon and using stitches and strong fibres, will bind it together to make a ligament that can be placed where the ACL one stood. Over time (6-9 months+) the tendon graft slowly changes its properties and becomes stronger and stronger, to eventually mimic a ligament. This option still required rehabilitation with one of our physios post-operatively and a typical return to sport timeline is 9 months, or more. Research suggests that for every month after 12 months, the likelihood of reinjury rate drops dramatically.
  3. Surgical option B – quadriceps/patellar graft
    In a similar vein to the hamstring graft, the surgeon will remove a section of your quadriceps tendon either above or below your kneecap. They will then again bundle this tendon together and place it where the original ACL was, and anchor it using stitches and screws. This option is preferred by some surgeons for a range of reasons, including age of the athlete, their chosen sport, physical composition of their individual muscles and much more. Again, with this option the surgery is only the start of the journey, as extensive rehab is required afterwards to ensure adequate strength is returned before a return to sport.

With any or all of these options, a detailed conversation with your physio, and the surgeon, is required to establish which option is most appropriate for you. Your individual circumstances will guide what is going to be the best option for you. These options listed above are just some of the possibilities available but are also dependent on other complexities of your individual injury like secondary injuries (meniscus, other ligaments etc), your age, your sport of choice and many more. If you’ve had a knee injury we welcome you to come in and chat to one of our Instinct Health physios about the nature of your injury and how we can help you best!

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ACL ruptures – an exploration of your options!