Anterior cruciate ligament (ACL) tears are a common and debilitating knee injury, often requiring surgical intervention. However, recent research has raised questions about the necessity of surgery for ACL tears, sparking controversy in the medical community.
A study published in the British Journal of Sports Medicine in June found that a new bracing protocol, combined with physical therapy, led to the healing of 90% of ACL tears in 80 participants. These individuals, primarily competitive or recreational athletes, also reported good knee stability and function and were able to return to their sports activities within a year.
The bracing protocol involved wearing a knee brace that kept the knee at a 90-degree angle for a month, a position that encourages the torn ends of the ACL to fuse together. Over the next two months, patients underwent physical therapy as their braces were adjusted to increase the range of motion. Braces were removed around the three-month mark, and MRIs performed at that time and again at six months showed that most ACLs had repaired themselves.
Traditionally, surgery has been the recommended treatment for ACL tears, involving the replacement of the torn ligament with a graft. While surgery can lead to a faster return to activities, it also carries risks, including complications such as kneecap pain, chronic instability, stiffness, infection, blood clots, and numbness.
The recent study suggests that nonsurgical treatment, including bracing, can be an effective alternative, particularly for individuals who may not play professional or competitive sports or have financial or health constraints preventing surgery. By immobilizing the injured knee at a 90-degree angle, similar to stabilizing a fractured bone inside a cast, this treatment maximizes healing.
Experts who support nonsurgical treatment argue that it may be a viable option, especially considering that ACL reconstruction does not guarantee the prevention of future injuries or the development of osteoarthritis, a condition that affects over half of ACL tear patients.
However, some experts remain unconvinced about the long-term stability of a self-healed ACL compared to a reconstructed one. Surgery can also protect the meniscus, a shock-absorbing cushion in the knee, from injury, and prevent further ACL tears. The decision between surgery and nonsurgical treatment depends on various factors, including the individual’s lifestyle, health, and athletic goals.
While controversy surrounds the new approach, further research and long-term follow-up studies are needed to determine its effectiveness and whether it can provide lasting stability and function to individuals with ACL tears.