Snap, Crackle, Pop...My ACL is torn. So now what?

A recent study published in the July issue of the New England Journal of Medicine questioned the benefits of immediate surgery following an ACL tear when compared to taking the less invasive route of physical rehabilitation.

Participants included 121 adults, ages 18-35, who were non-athletes. Half of the group opted for early surgery while in the remaining half of 59 patients, 36 did well with just the rehabilitation and 23 had surgery after almost 12 months of time. The results after 2 years of the incident found both groups did very well with no significant differentiation in pain and function from those who received immediate surgery versus those who chose to try therapy.

I am not saying that athletes beyond the age of growth plate exemption should never consider surgery, only pointing out the limitations of said patient's ability to return to sports is significantly increased when an operation on the ACL is performed in the acute stage of healing. The stiffness in the affected limb will only escalate with swelling, etc that follows surgery while the knee still did not yet have full motion and is now filled with blood.

Another concern to be addressed in light of knee injuries, which often results in a change of gait and subsequent shortening of some musculature due to substitutionary movements, is the close association with developing osteoarthritis or experiencing tears of the menisci. From the standpoint of a knee injury, osteoarthritis would develop most likely over the course of 15-20 years depending on the age and lifestyle of the patient. We must conclude then, 2 years is not a sufficient time frame when considering the long term effects of an injury.
However, physical therapy with or without surgery is beneficial for restoring strength in weak muscles and thereby reinstating stability, as well as the combination of modalities offered to help with inflammation and hands on treatment for improving mobility and function.

Physical therapy is often prescribed prior to surgery in preparation for what's to come and the subsequent knowledge provided by a therapist to a patient including ways to protect your knee from further damage or simply reassurance of sx on bad days can be invaluable.