ACL injuries occur at an incidence of approximately 100,000 to 200,000 per year in the United States. Athletes traditionally have feared this type of injury due to their concern with the likelihood of a full return to their prior level of function. With more advancements in surgical procedures and techniques, ACL injuries are no longer an athletic nightmare and most athletes see a return at or close to their pre-injury level of performance.

Traditional thinking and best orthopedic practice urges patients, especially those with a desire to return to athletics, to pursue surgery. The idea is that without the ligament in place there will be a significant increase in demand on the other ligaments and structures of the knee during athletic movements and an equally increased likelihood of developing knee arthritis years down the road.

A recent article titled “Does Anterior Cruciate Ligament Reconstruction Improve Functional and Radiographic Outcomes Over Nonoperative Management 5 Years After Injury?” published in American Journal of Sports Medicine revealed 5 year followup rates of 144 athletes were clinically insignificant between surgery and non-surgery patients with the outcomes being: pain scores, performance based testing, presence of arthritis, activities of daily living and knee related function.

All data should be scrutinized and certainly not generalized. By no means does this article offer perfect insight into best clinical practice and every case should be treated on an individual basis. What the article does suggest, however, is that surgical intervention, even ones that have been deemed necessary and best practice for many years by the leaders in orthopedics, may not ALWAYS be the right choice. Do your homework before committing to a surgery of any kind.

At Kauno, we pride ourselves in staying research driven because we owe it to our followers to provide information that is supported by quality data and not subjective reporting.

-Brendan Clarke, PT, DPT, CAMT, CSCS

Wellsandt, E., Failla, M. J., Axe, M. J., & Snyder-Mackler, L. (2018). Does Anterior Cruciate Ligament Reconstruction Improve Functional and Radiographic Outcomes Over Nonoperative Management 5 Years After Injury? The American Journal of Sports Medicine, 46(9), 2103–2112. https://doi.org/10.1177/0363546518782698