As discussed previously, ACL injuries are prevalent. They are a common injury in many pivoting sports popular in Australia. These “at-risk” sports include Australian Rules football, netball, soccer, rugby and basketball. Whilst not a pivoting sport, snow skiing also is associated with a high incidence of ACL injuries.
Treatment options for someone who has torn their ACL include surgery or physiotherapy-based rehabilitation. Surgery is typically indicated for active people keen to continue playing their chosen sports. Another common reason to perform reconstruction is the presence of a potentially repairable meniscus tear or associated ligament injuries.
If someone chooses not to have surgical reconstruction, they need an extensive rehabilitation program. Because ACL tears, by and large, don’t heal, a person with an ACL-deficient knee needs to seriously consider whether they need to stop playing “at risk” sports. If they return to pivoting sports, they have a high chance of re-injury. Unfortunately, a re-injury increases the risk of a more extensive injury, such as a meniscus tear that can cause the knee to lock. This type of meniscus tear has significant implications in the short term but can also be devastating for the long-term health of the knee.
A significant paper was published last year called the ACL-SNNAP trial (1). It was a randomised control trial comparing rehabilitation versus ACL reconstruction for non-acute ACL tears. Randomised control trials are the highest quality studies that can be performed. The study concluded that surgical reconstruction for non-acute ACL injury with persistent symptoms of instability was clinically superior compared with rehabilitation. Interestingly, there was no difference between groups in the proportion of intervention-related complications. The study also showed that surgical reconstruction was more cost-effective than rehabilitation management.
This study is further evidence of the importance of ACL surgery for those sports people who have torn their ACL.
1. Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial. David Beard and the ACL SNNAP Study Group. Lancet. Vol 400 August 20, 2022. 605-615