An ACL (anterior cruciate ligament) injury of the knee can be a devastating blow to any athlete. However, as research progresses and surgical interventions develop, the dreaded ACL injury may not be quite as bad as first thought.
Take Russ Henshaw for example. Russ is part of the current Australian winter olympics team headed for Sochi 2014. The slopestyle ski specialist injured his ACL for the second time preparing for the X games in January 2013.
He had to consider two options for recovering from his injury.
1. have reconstructive surgery and miss lead up training to the winter olympics and possibly not even get selection…or
2. go for conservative treatment by rehabilitating strength & stability to compete without an ACL.
Russ chose option no2.
Russ only had 4 weeks off the slopes. He has not only successfully competed without an ACL but is charging towards Sochi & looking for a medal.
ACL Injury treatment options
The goal of rehabilitation after an ACL injury is to return the individual to their previous level of activity, whether this be elite sport or your work, plus to prevent further injury to the knee.
There are now two options for treatment post ACL injury.
1. conservative management.
This is guided by your physiotherapist. Initial treatment will aim to reduce swelling, regain any loss of movement of the knee, then progress to strength, power and stability training, specific to your goal activity. This rehab program usually takes six months like the post-surgery program, but return to training can happen at about the 3 month mark.
2. reconstructive surgery.
Depending on your level and type of activity, surgery may be indicated to optimise stability of the knee. ACL reconstruction surgery usually involves making 2 or 3 small incisions around the knee, the torn ACL is removed and the replacement graft is anchored in to place.
Depending on the surgeon and the type of graft used, the length of rehabilitation varies. In terms of return to sport, as an average, you are looking at around 6-9 months, but may be back training at the 4 month mark.
Surgery vs No surgery
Russ Henshaw & recent research raises an important question “Do we really need to operate?”
A recent study has compared early ACL reconstruction to conservative rehabilitation. The conservative rehab group had the option to have surgery at a later stage if they still felt unstable.
The rehabilitation programs are relatively similar in the initial stages. The main differences relate to the timing of return to sports specific activities.
conservative:
– sport specific exercise at 3 months
– pre-injury level by 4 months
and for surgery:
– sport specific exercises at 4 months
– pre-injury level by 6 months
50% of subjects who started with conservative rehab, later went for an ACL reconstruction due to ongoing episodes of instability. The other 50% at 5 year follow-up had no significant difference in osteoarthritis, return to pre-injury activity level or a need for further surgery.
If you are an athlete, the decision to go for conservative rehab might be difficult due to the 50/50 possibility of later requiring surgery anyway & a further 6 months rehab again after that.
This might be an easier decision for those who don’t have high demands on their knee for everyday activities & don’t play sport, as ongoing instability at this level is less likely. In this study, 50% of people who would otherwise have had surgery as standard treatment option, did not need to, with no adverse affects 5 years down the track.
Unfortunately the recent research did not involve professional athletes so we are very interested in watching Russ Henshaw in the winter Olympics. Can a conservative rehabilitation program, designed specifically for a particular sport outweigh the presumed importance of an ACL for knee stability?!
Stay tuned for our next blog on surgical options with the different graft choices.
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