ACL – which approach?

conservative approach vs operative approach (surgery or not) – which one should you choose? an in-depth review of each treatment.

So you have injured your ACL, now you need to know what to do… Can I get away without surgery?

Injuries to the anterior cruciate ligament (ACL) can be distressing, and deciding on the appropriate treatment approach is crucial. One of the primary considerations is whether a conservative or operative approach is suitable for your ACL injury. Let’s explore these options further and weigh the pros and cons of each.

What is a conservative approach to ACLs?

    A conservative approach to ACL injuries involves non-surgical management, focusing on rehabilitation, physiotherapy , and lifestyle modifications. This approach is typically recommended for individuals who have:

    • Partial ACL tears
    • Low activity levels or minimal functional instability
    • No significant damage to other structures in the knee joint
    • Limited demands on the knee joint in their daily activities

    Conservative treatment aims to restore strength, stability, and function through exercises that strengthen the surrounding muscles, improve range of motion, and enhance proprioception. Physical therapy may be combined with bracing to provide additional support to the knee during the healing process.

    Pros of a conservative approach

    • Non-invasive: Conservative treatment avoids the risks associated with surgery, such as infection, anaesthesia, and potential complications.
    • Faster recovery: Rehabilitation can typically begin immediately after the injury, allowing for a quicker return to daily activities.
    • Avoids surgical risks: Some individuals may prefer to avoid the potential risks and complications associated with surgery.


    Cons of a conservative approach

    • Increased risk of knee instability: Without surgical intervention, there may be a higher risk of ongoing knee instability and functional limitations.
    • Limited efficacy for certain activities: Conservative treatment may not provide sufficient stability for individuals participating in high-demand sports or activities.
    • Potential long-term consequences: In some cases, untreated ACL tears can lead to secondary knee problems, such as meniscal tears or osteoarthritis.


    What is an operative approach to ACLs?

    When ACL reconstruction surgery is necessary, there are several tendon options available for grafting. The most commonly used tendon choices include:

    An operative approach involves ACL reconstruction surgery, which is often recommended for individuals with:

    • Complete ACL tears
    • High activity levels or functional instability
    • Concurrent injuries to other structures in the knee joint
    • A desire to return to demanding sports or activities

    ACL reconstruction surgery aims to restore knee stability by replacing the torn ACL with a graft. The most common graft options include autografts (using the patient’s own tissue, such as the patellar tendon or hamstring tendon) or allografts (using donor tissue). The surgical procedure involves securing the graft in the knee joint through various techniques, allowing it to gradually heal and integrate with the surrounding tissues.

    Pros of a operative approach

    • Restored knee stability: ACL reconstruction surgery aims to restore knee stability and reduce the risk of future instability episodes.
    • Improved functional outcomes: Surgical intervention can often lead to better functional outcomes, allowing individuals to return to demanding sports or activities.
    •  Lower risk of secondary injuries: ACL reconstruction may help prevent the development of secondary knee problems, such as meniscal tears or osteoarthritis.

    Cons of a operative approach

    • Invasive procedure: ACL reconstruction surgery involves inherent risks associated with surgery, such as infection, bleeding, or anaesthesia-related complications.
    •  Prolonged recovery: Recovery from ACL surgery typically takes several months, including rehabilitation and physical therapy.
    • Potential for graft failure: There is a small risk of graft failure or re-tearing of the reconstructed ACL.

    Overall conclusion – making the right choice

    The decision between a conservative approach and operative approach for ACL injuries depends on various factors, including the severity of the tear, individual activity level, and personal preferences.

    While a conservative approach may be suitable for individuals with partial tears or limited functional instability, ACL reconstruction surgery is often recommended for those with complete tears, high activity levels, or significant knee instability. 

    We are here if you have any questions or need a consult to further discuss your treatment options.