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.
What are the 3 treatment options for ACL tears?
- Treatment option #1: Rehab alone (without surgery)
- Treatment option #2: ACL surgery + post-op rehab
- Treatment option #3: Rehab before surgery + ACL surgery + post-op rehab
What all 3 treatment options for ACL tears have in common:
All 3 treatment options for ACL tears have the following in common:
- Begin with an Impairment phase
- Aim to address psychological barriers
- Require significant amount of time each week
- They are all HARD
- They all have the same goal
Impairment Phase
No matter which of the 3 treatment options you decide on, they all begin once the “benchmarks” are acheived.
Addressing Psychological Barriers
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!
They all require a significant amount of time each week
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.
They are HARD!
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.
They all have the same goal
All 3 treatment options for ACL tears have the same end goal in mind, which is to improve motion, strength, balance, and athletic ability.
How long do each of the 3 treatment options for ACL tears take?
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.
Time to complete treatment option #1: Rehab alone
Impairment phase = 1-2 weeks
Rehab phase = 35-50 weeks
Total time = 36 weeks to 52 weeks
Time to complete treatment option #2: ACL surgery + post-op rehab
Impairment phase = 1-2 weeks
Post-op rehab phase = 36-52 weeks
Total time = 37 weeks to 54 weeks
Time to complete treatment option #3: Prehab +ACL surgery + post-op rehab
Impairment phase = 1-2 weeks
Prehab phase = 5 weeks
Post-op rehab phase = 36-52 weeks
Total time = 42 weeks to 59 weeks
Do the outcomes differ between the 3 treatment options for ACL tears?
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.
Resources
- [1] Failla MJ, Logerstedt DS, Grindem H, et al. Does Extended Preoperative Rehabilitation Influence Outcomes 2 Years After ACL Reconstruction? A Comparative Effectiveness Study Between the MOON and Delaware-Oslo ACL Cohorts [published correction appears in Am J Sports Med. 2017 Apr;45(5):NP9]. Am J Sports Med. 2016;44(10):2608-2614. doi:10.1177/0363546516652594
- [2] Adams D, Logerstedt DS, Hunter-Giordano A, Axe MJ, Snyder-Mackler L. Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression. J Orthop Sports Phys Ther. 2012;42(7):601-614. doi:10.2519/jospt.2012.3871
- [3] Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019;33(1):33-47. doi:10.1016/j.berh.2019.01.018
- [4] Wellsandt E, Failla MJ, Axe MJ, Snyder-Mackler L. Does Anterior Cruciate Ligament Reconstruction Improve Functional and Radiographic Outcomes Over Nonoperative Management 5 Years After Injury?. Am J Sports Med. 2018;46(9):2103-2112. doi:10.1177/0363546518782698
- [5] van Yperen DT, Reijman M, van Es EM, Bierma-Zeinstra SMA, Meuffels DE. Twenty-Year Follow-up Study Comparing Operative Versus Nonoperative Treatment of Anterior Cruciate Ligament Ruptures in High-Level Athletes. Am J Sports Med. 2018;46(5):1129-1136. doi:10.1177/0363546517751683
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