Study shows surgery might not be needed
A study of Swedish amateur athletes—mostly soccer players—found that those who got an ACL reconstruction right away plus physical therapy fared no better than athletes who started out with rehab and got the surgery later if they still needed it.
Of those in the rehab-first program, fewer than half went on to get the surgery within two years, researchers reported in Thursday’s issue of the New England Journal of Medicine.
“It seems that if you start out with rehabilitation only … you have a good chance of ending up with an equally good outcome as if you had early ACL surgery,” said Richard Frobell of Lund University Hospital in Sweden, an author of the work.
“Maybe we will be surprised that a lot of people actually do not need an ACL reconstruction.”
Frobell stressed that the study did not include professional athletes. They usually seek surgery to get back into action quickly rather than waiting to see if rehabilitation works.
About 200,000 Americans each year have surgery to replace the anterior cruciate ligament, or ACL, which is crucial for knee stability. It can get torn in sports like football and soccer that require planting the foot and pivoting.
Doctors already knew that not every patient with a torn ACL needs surgery; a middle-aged jogger or cyclist can often get by with a knee brace and rehabilitation, experts say. Frobell said his work suggests that the same strategy might work for athletes who want to return to more strenuous sports such as soccer, at least on lower competitive levels.
Some patients with a damaged ACL can cope well at a high level. But doctors can’t reliably predict which ACL patients will turn out to be “copers,” and Frobell acknowledged his work doesn’t help with that.
Doctors and patients currently decide on whether to do the surgery depending on individual factors like just what physical activities the patient plans to pursue and the overall health of the knee, said Dr. Bruce Levy, a Mayo Clinic surgeon.
The operation is an outpatient procedure that involves replacing the ACL with tissue from the patient or a cadaver. Risks include infection and stiffness that may require more surgery. The surgery costs $10,000 or more, depending on whether cadaver tissue is needed.