ACL Surgery - Who Needs It vs. Not? Can ACL Injuries Heal On Their Own?

[@fabcarfor2370]

Perfect explanation, congrats and thank you!

[@SportsInjuryPhysio]

You're welcome!

[@echabani9784]

Thanks for this excellent informative explanation, unbiased and research supported! It help me decide for rehab of my ruptured ACL

[@SportsInjuryPhysio]

Glad it was helpful!

[@calebkayanja9170]

@@SportsInjuryPhysio would a raptured ACL heal with just physical therapy or definitely it has to be surgery?

[@somebodytookmyname1]

Thanks for this comprehensive explanation. When plenty of people will adamantly, anecdotally insist on healing ACL one way, you’ve cut through the BS with research. Much appreciated!

[@SportsInjuryPhysio]

You're welcome!

[@carltonholmes8061]

Tore mine in 1984 racing MX. Never got it repaired. It was unstable and did do damage to cartilage eventually. I used to run on it for 10 yrs till the early 90’s Eventually i started Mountain Bike racing.Stability was better as my muscles got stronger. In 2022 after no.9 operation i eventually had to have a replacement due to having Bone on Bone arthritis for 8 years(Still cycling). So now my knee is great and i still MTB and Cycle many miles. I was told that my knee would have worn out earlier if i had my ACL Replaced at the time as it would have put more stress on the Cartilage once the Meniscus had disintegrated. Sorry about the epic story. 😊

[@SportsInjuryPhysio]

Thanks for sharing!

[@muhammedabulhafizurrahman663]

No 9 surgery? U had 9 surgeries, what ?!!!😮 care to elaborate plz

[@carltonholmes8061]

@@muhammedabulhafizurrahman663 yes, i started in 1984 though. With micro-fracture in 2009 which kept me going till 2020 then arthritis got just too bad after 2 more surgeries and finally ended up with a Full TKR done by MAKO Robot assisted surgery in Jan 2022.

[@muhammedabulhafizurrahman663]

@@carltonholmes8061 Damn man, and u still cycle,🫡🫡🫡

[@carltonholmes8061]

@@muhammedabulhafizurrahman663 yes, just brought a new Epic MTB as well. Can ride 45miles on road in 2hr 20ish and 2hr+ mountain bike rides with big climbs too, loving it. Also do 12 mile hill hikes when away. Got a new lease of life from my TKR. 🙏thanks for the interest.

[@mariatranslator]

Great content ❤

[@chrisbosgraaf5923]

13 year old acute ACL damage during a basketball game. Found a few doctors that didn't want to treat because of his age. Really hoping to be able to pitch (baseball) again in spring. Have seen both with he doesn't need surgery because of his age and others that say surgery is needed.

[@SportsInjuryPhysio]

Usually they don't do surgery at that age because the body has a great ability to heal - if they review it after at least 12 weeks of rehab and it is still unstable, then they may opt for a different treatment.

[@jayamador6292]

thankyou so much maam ...you help me to recover ..i want to have treatment

[@SportsInjuryPhysio]

Please see my response to your comment on the other video.

[@Hdrb_16]

I have a cruciate ligament. I had an MRI and it showed that it was completely torn. I had it done again and it became almost complete. All the orthopedists tell me that I must have surgery. But the physical therapists have another opinion. That there is healing and I must complete the rehabilitation, but the orthopedists do not agree with its ability to heal, which made me confused. I have been injured for a year and a half.. I do not know what to do. As I am continuing with rehabilitation without surgery, I fear that all my efforts have been in vain and I must have surgery and rehabilitation, which makes me feel very frustrated. I have been rehabilitating without surgery for 10 months and I have not tested myself yet as I am very normal, but I cannot play football and I have not tried yet because of my extreme fear of betraying the knee as it has only betrayed me 3 times before and it is very painful .. I felt bloated and puffy at the beginning of the first months of rehabilitation, but it completely disappeared after the second month. I feel very normal, but I have not tried playing football. I only have a semi-complete tear and the rest is completely fine.

[@SportsInjuryPhysio]

If your knee is feeling stable during normal daily activities and your physio is slowly progressing your rehab to include complex activities involving twisting, turning, running then I would see if you can get back with rehab only. The research shows that ppl can get back to full sport even if the MRI is still showing the tendon not fully together AS LONG AS they have built up to it with the correct rehab. So go on what you can do in rehab rather than what the scan shows.

[@Hdrb_16]

@SportsInjuryPhysio I will continue with the rehabilitation but the specialist told me that there is healing but the second MRI is not very clear and I have to do it again and he does not have a clear plan just exercises .. as he takes leave and is absent continuously and took a long leave for two months and when I returned he seemed upset that he reached the maximum number of sessions with me I did not get a single piece of information whether to do the operation or not, I feel that I wasted my time as I was about to have the operation but I continued with the rehabilitation and he asked me if I felt if I would do the operation or not a few days ago and I felt frustrated but I do not have any symptoms I feel completely healthy and I can run but I am very afraid of betraying the knee .. I contacted another specialist without telling him the opinion of the specialist I am following up with and he told me that there is healing and he also asked for the CD that I have the specialist I am following up with and he said there is healing I told them that the surgeon told me to have the surgery but they insisted on continuing with the rehabilitation

[@Hdrb_16]

@SportsInjuryPhysio The result of the first report dated 11/23/2023. Clinical Information: Trauma Report MRI right Knee: Chronic complete ACL tear from its tibial attachment. Normal medial meniscus. Normal articular cartilage in the medial compartment. Normal lateral meniscus. Normal articular cartilage in the lateral compartment. Normal posterior cruciate ligament. Normal medial collateral ligament. Normal lateral collateral complex. The patellar articular cartilage looks normal. Normal trochlear groove. Normal quadriceps and patellar tendons. There is no significant effusion within the knee. Conclusion: Chronic complete ACL tear from its tibial attachment. Report Partially validated by, The result of the second report dated 5/19/2024. Reason for study twisting injury Rt knee CO clicking Lachmann test and Pivot shift test are positive McMurry test are negative Plan Xray and MRI requested Clinical Info: twisting injury Rt knee CO clicking Lachmann test and Pivot shift test are positive McMurry test are negative Plan Xray and MRI requested Diagnosis: Allergies: No Known allergies, Technique Multiplanar multi sequential MRI study of the right knee joint. Findings The medial collateral ligament is intact. The iliotibial band, biceps femoris tendon, lateral collateral ligament and popliteus tendon are intact. The anterior cruciate ligament showing significant near total fibrous disruption along its femoral attachment with sagging down of remaining fibers upon tibial plateau. The posterior cruciate ligaments is intact. PHMM and body mild mucoid degeneration. The lateral meniscus is grossly intact. The quadriceps and patellar tendons are normal. The visualized osseous structures demonstrate normal bone marrow and cortical signal intensity without evidence of fracture, trabecular bone injury or dislocation. There are no osseous lesions are identified. No significant chondral defect is seen. Minimal joint effusion is seen. Minimal deep infra patellar bursal fluid. No popliteal cyst is identified. Soft tissue are otherwise normal. Conclusion ACL high grade almost complete chronic tear. Knowing that they are all in different hospitals because the doctors refuse to let me do it again, claiming that it cannot heal.

[@Hdrb_16]

@SportsInjuryPhysio The result of the first report dated 11/23/2023. Clinical Information: Trauma Report MRI right Knee: Chronic complete ACL tear from its tibial attachment. Normal medial meniscus. Normal articular cartilage in the medial compartment. Normal lateral meniscus. Normal articular cartilage in the lateral compartment. Normal posterior cruciate ligament. Normal medial collateral ligament. Normal lateral collateral complex. The patellar articular cartilage looks normal. Normal trochlear groove. Normal quadriceps and patellar tendons. There is no significant effusion within the knee. Conclusion: Chronic complete ACL tear from its tibial attachment. Report Partially validated by, The result of the second report dated 5/19/2024. Reason for study twisting injury Rt knee CO clicking Lachmann test and Pivot shift test are positive McMurry test are negative Plan Xray and MRI requested Clinical Info: twisting injury Rt knee CO clicking Lachmann test and Pivot shift test are positive McMurry test are negative Plan Xray and MRI requested Diagnosis: Allergies: No Known allergies, Technique Multiplanar multi sequential MRI study of the right knee joint. Findings The medial collateral ligament is intact. The iliotibial band, biceps femoris tendon, lateral collateral ligament and popliteus tendon are intact. The anterior cruciate ligament showing significant near total fibrous disruption along its femoral attachment with sagging down of remaining fibers upon tibial plateau. The posterior cruciate ligaments is intact. PHMM and body mild mucoid degeneration. The lateral meniscus is grossly intact. The quadriceps and patellar tendons are normal. The visualized osseous structures demonstrate normal bone marrow and cortical signal intensity without evidence of fracture, trabecular bone injury or dislocation. There are no osseous lesions are identified. No significant chondral defect is seen. Minimal joint effusion is seen. Minimal deep infra patellar bursal fluid. No popliteal cyst is identified. Soft tissue are otherwise normal. Conclusion ACL high grade almost complete chronic tear. Knowing that they are all in different hospitals because the doctors refuse to let me do it again, claiming that it cannot heal.

[@muttusouri222souriamma9]

Thank you ma'am for a clear explanation. I have a high grade partial tear in acl and also slightly in MCL too. Alao a collateral ligament tear. Please do let me know if arthroscopic surgery is too necessary. As people amd my parents are also confusing to go without surgery. My age is 42. I am a teacher.

[@SportsInjuryPhysio]

If it is a partial tear and no meniscus injuries, then you might be OK with rehab only. But I can't really tell for sure without assessing you. There is usually no harm in first trying rehab for at least 12 weeks before deciding.

[@wmhashmi]

Excellent video - very informative, research supported and unbiased! Do you know if using a brace can help compensate for a torn ACL - is it recommended or as some people say could it end up causing supportive parts of the knee to actually weaken due to reliance on the brace and therefore not having to work as hard?

[@SportsInjuryPhysio]

Braces are essential during the first few weeks of ACL rehab. Then, once your rehab has progressed to where your knee is stable, they are usually discarded.

[@jackvinz]

My sincere gratitude for this very comprehensive and logical explanation backed with sufficient research. One important factor that is not covered in the video is regarding nutrition that the ligaments (ACL included) require to build themselves up during recovery and physiotherapy phase. I heard that collagen, milk and vitamin D would help. Do you agree with this and can you suggest any nutrition reference that is hopefully backed by some research?

[@jackvinz]

BTW I'm recovering from fractured tibia, partial torn ACL+PCL and partial torn horn meniscus lateral. Underwent surgery to install plate for the tibia one month ago and orthopedic doctor recommended conservative rehab for ACL+PCL+meniscus. My physio sessions went well and ROM is improving. Am hoping to test out the knee once the doctor allows me to apply partial & full body weight in upcoming 1-3 months. Fingers crossed...🤞

[@SportsInjuryPhysio]

There is no strong evidence that supplementing with anything really helps unless you have a deficiency e.g. if you are Vit D deficient then definitely it can help if take Vit D. As for collagen - there is some evidence it might help with tendon recovery but I've not come across ligament recovery.

[@danieljones4916]

Ive got a grade 2 tear in my acl from football .im a roofer by trade . Still been climbing laddders.roofs .bumping tiles up etc . I can run quite fast in straight line . But reckon im still going to need surgery to get back to football 😢

[@muhammedabulhafizurrahman663]

Same

[@P84torres]

Do you think it's possible for an MRI to show the ACL is completely injured or to a high degree, but 5 doctors have already done the physical test on my knee and haven't found any instability in the knee. Have you ever had cases like mine? Thanks

[@SportsInjuryPhysio]

Yes, it is actually also well-documented in the research. In many of the studies where they look at ACL recovery after rehab, they often find that the knee has full function and no physical sign of instability after the rehab, but the scans still show that it is torn. If the person just wants to get back to unidirectional sport (e.g. running) then they are usually find to carry on - if they want to get back to sport that involves quick twisting and turning (like soccer) it is usually advised to get surgery.

[@P84torres]

@SportsInjuryPhysio in my case, its not after rehab, It was exactly after the injury that I had the MRI and the tests were carried out. One of the doctors said to repeat the MRI in 3 weeks because he said the knee had a lot of fluid! If I don't have instability, do you think I can play tennis or would it be better to have surgery? Thanks in advance 🙌🏻

[@ramaarun4667]

Is it the ACL will grow back after complete tear or partial tear, for those didnt undergo surgery but alternative treatment ?

[@SportsInjuryPhysio]

I discuss that in detail in the video.

[@Shanaya-d6j]

I tore my ACL partially and done a rehab without surgery. its been 6 months since the injury but still I can observe that my knee is swollen. I am able to walk, climb stairs. Can you suggest why swelling is still there?

[@SportsInjuryPhysio]

Knee swelling can take a very long time to go away - if you're functioning without pain and things are getting better in general, it is usually just part of the normal healing and will go eventually.

[@rommelfernandez1096]

​@@SportsInjuryPhysio Does that mean he will need to continue ice instead of warm compress while there's still swelling even after months since injury?

[@aungkoko9538]

I torn ACL two weeks ago 😢, I can walk but can't climb stairs feel very unstable ‌and knee is swollen

[@BennyHillLeavesComments]

Is the hamstring graft more appropriate for a very active 40 year old that runs 100 milers, goes to jujitsu 2-3x/week, and squats heavy?

[@SportsInjuryPhysio]

I'm not up to date with what type of graft is the best - a surgeon who does repairs and have to stay up to date with the latest research in this area is the best person to ask.

[@Bannister99]

Fatastic explanation and pleased to say it matches exactly what my surgeon told me, and I have chosen to try rehab for my ruptured ACL.

[@SportsInjuryPhysio]

Thanks for watching!

[@WAGR2687]

I partially tore my acl about 22 years ago, I had an mri last wich showed acl is damage, up until today the pain is unbearable I did physical therapy last year for 8 months but the pain keeps coming back.

[@mayankjain8008]

Hello i am 18 and tore my acl . The MRI shows a significant ACL tear, along with a small fracture and bone bruising in the knee. There is also some fluid build-up in the joint, likely due to bleeding from the injury. What should be done for this? My doctor has done a plaster for a month and says there will be a month of rehab and then surgery . What should be done according to you?

[@SportsInjuryPhysio]

Hi there, We cannot provide individual treatment advice without doing an in-depth assessment of your injury and your personal circumstances, as the advice might not be appropriate for you. You're welcome to book a video consultation with one of our physios if you would like an assessment and a personalised treatment plan: www.sports-injury-physio.com/

[@prantoahmed2909]

How did it happen and what did you feel after that.

[@iridiumvalkyrie9017]

this may not belong here, but none of my doctors seem to care that my knee started bruising in the joint space without trauma. I have one large and one medium chobdral defect in both the lateral and medial facets of the patellar joint and I’m being denied a partial knee replacement because "I'm too young" so I’m pushing through it to make it worse so doctors take me seriously and it started bruising while swimming no impact. Can I push through that? It's messing up my entire pt routine and life so I need help and not age discrimination.

[@SportsInjuryPhysio]

First, you need to make sure that you've really given physiotherapy a good chance - physiotherapy can't work if you continue to push into pain and aggravate it - you have to first calm the pain down and then slowly build your strength back up. The reason doctors often advise against surgery is because for many situation it doesn't really make a big difference - so it can be also due to that reason. However, if you feel that you have given your knee a fair chance at rehab and it is not responding, then I think you need to get a second opinion from a different doctor and really explain the emotional and physical impact of this.

[@iridiumvalkyrie9017]

@@SportsInjuryPhysio Thank you for your reply. I was in physical therapy for a year for my knee, but I have a large chondral defect on the medial facet of the patella and a medium cartilage flap on the lateral facet of the patella. I have gotten multiple surgical opinions for MACI and was told I am not a candidate due to the global cartilage loss. I cannot walk any distance on the right knee. I can't do my PT for my hip well (it's also bone on bone after not being taken seriously for nine years for a torn hip labrum that was causing debilitating pain and now has global cartilage loss) and the knee impairing my swimming as well. I cannot use stairs and it hurts to use the brakes in my car. Doctors don’t take me seriously in the United States because of my age and half of them won't accept my secondary insurance and won't let me pay the difference after my primary insurance. The doctors I have seen dismiss my pain and lack of quality of life. I've tried PRP injections to help lower the inflammation as well as Gel One and Supartz injections, had one scope to debride the initial chondral defect. The original surgeon didn't take x rays so he missed my patella alta and refused to do the MACI surgery until I had a genetic test for ehlers Danlos (doesn't exist) and I got generalized genetic testing for connective tissue disorders, which came back negative. By the time we reviewed my case the cartilage loss expanded. The patella alta is the cause of my bilateral knee pain/chondromalacia patella and cartilage loss. My left knee has a near full thickness fissure in the medial facet of the patella which I was told won't be helped with a tibial tubercle osteotomy either so I feel like I have no options except for nerve ablation but that is off-putting because it’s not curative. I cannot work because of the pain I am in and I want to be able to finish school and go to work and I was told I need a partial knee replacement but all the surgeons I’m seeing tell me I’m too young and they don’t care that I have no life and no quality of life. So I figured just push through the pain and keep making it worse until someone takes me seriously. I I have a new MRI ordered after the right knee started bruising without trauma, during swimming. I believe there was mechanical trauma perhaps because I did not hit it on anything and it was swollen for 48 hours so I am not sure what happened but I can only assume that I ripped one of the flaps off the bone again. The American healthcare system only cares about those with money and is not based around preventative care. I am extremely frustrated and in horrible pain. Ice is nice but cartilage won't regrow.

[@beautifulgamef]

Sis i have grade 2 lateral meniscus tear and lcl strain with mild buckle I have no problem while walking and straight running even side running But the mild buckle is still there please suggest me

[@SportsInjuryPhysio]

If by buckle you mean it feels unstable then it sounds like you need rehab for the LCL strain - you can find information about the rehab in this playlist: kzbin.info/aero/PLkRW4ITRa6bAQBWyt4wVRMh1bpFIjzwi-

[@Shantveer1999]

Hi madam m from India One year ago I had an accident, then I put plaster for 2 months, now 6 months ago I was having knee pain, then I did an MRI, then ACL was 22mm damaged showing now doctors suggesting for arthoscopy shall I go for it Else it will heal naturally?

[@SportsInjuryPhysio]

I can't advise on what is best for you without understanding your full context. Your doctor is best placed to advise on your situation.

[@AKB-cs8kw]

I have partial acl tear and medial miniscus tear, its been 6 weeks and i started physio 10 days ago should i try conservative first? Im not going into sports just want normal day activities to go on

[@SportsInjuryPhysio]

Yes, conservative is usually the best first option if you don't want to get back to high impact twisting sports. Your physio will assess your progress after 6 weeks and be in a better place to advise if you stick to conservative or should consider surgery.

[@Artzimer1958]

I would wait. You have partial injuries. I tore my ACL and MCL in both knees 4 months ago and I’m waiting to see if i can get by without surgery.

[@Artzimer1958]

My left knee injury was worse than the right side but i tore both ACL and MCL in both knees 4 months ago. I’m very active 60 years old. I’m devastated. My knees are not hundred percent stable, but I am still going to wait and see. At the moment I am doing my own strengthening exercises. I Purchased BFR training bands. I am fighting to save myself from going under surgery and dealing with a long rehab.

[@hgstkuching]

Injured my knee during a football game Mri showed I have grade 2-3 acl Grade 2 pcl lcl mcl Partial lpfl Should I really go for acl reconstruction surgery? I don't really mind stopping all sports, though i want to switch to gym.

[@SportsInjuryPhysio]

Discuss it with your doctor and ask if it would be OK to delay surgery and focus on rehab and getting strong in the gym to see what you can achieve through that. As I understand it, it doesn't matter if you delay surgery if you don't go back to pivot type sports and then decide to have it later (if you still need it) but I am not an expert on this.

[@rommelfernandez1096]

​@@SportsInjuryPhysiois trail running considered pivot sports?

[@bpoyraz1266]

Hi there . I am 14 years old and I ripped my Acl (%100) while playing basketball. I went to a Professor that is the best in my area. He said we cant do a surgery cause I am young and he said it can heal without surgery. I am so confused cause when I look to the internet they say it cant be healed. By the way my doctor said it is better than 3 months ago. What are your thoughts ?

[@SportsInjuryPhysio]

Your doctor is correct. It can heal and especially if you are young it has a very good chance of healing. So do your physio and get your leg strong and it will very likely be find without needing surgery.

[@isaiahdiaz1754]

I have a full rupture acl injury happened in 2021 first didn’t have stability the next year I had gain a lot of stability due to previous job lifting trash and still having motion to run and jump still sometimes had a buckling sensation when hoping off and in the truck know I would like to go in the military I have been self caring do strengthening workouts and leg exercises every day would it recommend since I already have stability in my knee should I do a rehab ?

[@SportsInjuryPhysio]

It is always good to keep general strength and stability maintained - so doing general strength and stability training for your knee twice a week should be enough to maintain control if you currently have full function.

[@rommelfernandez1096]

With a partial MCL tear, grade 2 ACL tear , can walking make it worse like completely rupture it?

[@SportsInjuryPhysio]

Only in the early stages and if you walk without your brace and go on very uneven terrain or step on a stone or something that cause your leg to twist. If you wear your brace, you should be fine.

[@Diego-lj7cw]

Hey so I tore my acl in June but the pain was not as bad when I tore my left acl the year before what can this mean ?

[@SportsInjuryPhysio]

Pain doesn't actually indicate or mean much. MRI scans have shown that some people have nearly no injury but severe pain and others can have severe injuries with no pain. And other times the same level of injury can cause either severe or no pain. Pain seems to be linked to more than just your level of injury.

[@jstacey2875]

Hi , i have recently begun the journey of healing conservatively in the hopes of returning to a high level pivoting sport. i have a ruptured ACL + Lateral Meniscus tear. its been roughly 4 weeks since the Injury. in your opinion do you think this is a good option to try to heal naturally and return to this kind of sport ?

[@SportsInjuryPhysio]

The research seems to suggest that surgery is the better option if you have a meniscus tear + ACL tear. But there are always exceptions to the rule and there usually isn't any harm in first trying rehab and seeing how far you get with that.

[@Artzimer1958]

It’s been four months since my first MRI reports that showed I tore both my ACL and MCL both knees in ski accident. I really want to get another MRI but my doctor is resisting to give me a prescription. In your opinion when is a good time to do the second MRI to see if there was any progress or not.? I have chosen to go without Surgery .

[@SportsInjuryPhysio]

We usually don't do a second MRI unless the patient isn't progressing. The reason being that the knee can regain full stable function even if the ACL does not look pristine. So at this point it is about whether or not your physical tests that your doctor do are stable and you're progressing with your rehab. An MRI won't add anything to making decisions for treatment hence why your doctor is reluctant to get one.

[@wmhashmi]

In the video you say that some people can grown back/heal their ACL so wouldn't a second MRI at some point provide value if it showed you're one of this group that shows ACL healing and can then reinforce a decision to avoid survey? Or in other words - one does show progress with just rehab at what point then would you recommend an MRI?

[@prantoahmed2909]

Hey, what did you feel after your accident, was it painful to walk?

[@dineshratnakar6586]

Bulky ACL sprain will heal naturally?

[@SportsInjuryPhysio]

I'm not sure what a bulky ACL sprain is - best to ask your doctor.

[@pranitadhakal1011]

Hello what about mucous degeneration of ACL ?? Will they heal on its own

[@SportsInjuryPhysio]

As far as I know surgery is the treatment of choice for mucoid degeneration of ACL - I don't know if it responds to conservative treatment

[@potigai]

it is very good informative, God sent me this eyeopener video

[@darlingdior]

I think God sent me this too to ease my mind

[@Shantveer1999]

Here all doctor's telling for scopy only

[@beautifulgamef]

Sir can you reply to my comments!

[@btugrul]

Thanks a lot for all these clarifications. My question is whether an ACL tear requires surgery has also to do with the grade of the tear? For example, I wonder if a grade 1 ACL tear would require surgery or it can simply be controlled through a serious rehab program?

[@SportsInjuryPhysio]

There are cases of full tears being managed successfully through rehab, so the grade does not seem to be the main thing that affect the decision. But I would say that for a grade 1 I would always do rehab for my first option of treatment as it is very likely to not need any surgery.