Before going to Physical Therapy school, I always assumed surgery was mandatory when you tear your ACL.
Man, was I wrong!
In todays management of ACL tears, there are not one, not two, but 3 treatment options for ACL tears!
The rehab process for any ACL tear is extensive, so it is vital to be working with a surgeon or PT that is aware and educated on all 3 treatment options for ACL tears.
This will ensure you choose the treatment option that will allow you to achieve your goals.
All 3 treatment options for ACL tears have the following in common:
No matter which of the 3 treatment options you decide on, they all begin once the “benchmarks” are acheived.
This is arguably one of the most important components of all 3 treatment options for ACL tears.
Regardless of the treatment option, fear of reinjury has been found to be a bigger concern than the knee itself in athletes returning to sport [3].
For that reason, improving your confidence will be emphasized in each treatment option!
In order to achieve optimal outcomes, you should expect to dedicate a minimum of 2-3 hours per week towards recovering from your ACL tear.
No matter which treatment option you decide on, there is NO EASY OPTION.
All 3 treatment options for ACL tears require commitment, perseverance, and sacrifice.
All 3 treatment options for ACL tears have the same end goal in mind, which is to improve motion, strength, balance, and athletic ability.
Before I dive into each of the 3 treatment options for ACL tears, I want to emphasize that the time frames below are only estimates. It is hard to know exactly how long a person’s ACL rehab progress will be!
This is because the rate an individual progresses through ACL rehab is different in everyone.
For this reason, many ACL tear protocols are “criterion based” rather than “time based.”
That is, progressing to the next phase of rehab is based on whether or not an individual is able to pass specific requirements rather than solely based on an estimated timeframe that the phase should last.
Impairment phase = 1-2 weeks
Rehab phase = 35-50 weeks
Total time = 36 weeks to 52 weeks
Impairment phase = 1-2 weeks
Post-op rehab phase = 36-52 weeks
Total time = 37 weeks to 54 weeks
Impairment phase = 1-2 weeks
Prehab phase = 5 weeks
Post-op rehab phase = 36-52 weeks
Total time = 42 weeks to 59 weeks
As of now, there is not enough high quality evidence to make statements about which treatment option for ACL tears is superior.
For example, the rehab protocols that have been used to research outcomes using rehab alone (without surgery) does not consist of the best evidence.
For instance, in these studies, subjects were advised to reduce activity their level [3], which is not currently recommened.
Furthmore, it is hard to compare the outcomes between the treatment options as patients often decide on a treatment option based on their goals.
For example, those looking to return to competing at a high level often decide to have surgery. As such, the definition of a “successful outcome” varies between each option.
That being said, evidence is beginning to emerge that shows all the 3 treatment options are a viable option [3] [4] [5].
In summary, MORE RESEARCH IS NEEDED before conclusions can be made regarding which of the 3 treatment options for ACL tears is superior.
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