“Ruptured anterior cruciate ligaments don’t heal”.
This might be one of those stories clinicians tell patients and start believing themselves! This misplaced belief leads to a low threshold to undergo surgery with the expectation that a return to sport is only possible after reconstruction.
Of course, an intact or at least functioning ACL is only one factor contributing to stability. The joint surfaces, other ligaments, muscle strength and proprioceptive ability all matter. In capable hands, ACL reconstruction can improve instability. It is unlikely to restore the pre-injury function of the ligament and is followed by a period of swelling, muscle disuse, graft reconstitution and prolonged rehabilitation, all of which impair functional stability.
Surgery is but “controlled trauma”, and aims to reduce disability, not restore normality.
Surgery is not always required for a return to sport and satisfactory functional outcome after an ACL injury. Patients can often tolerate an amount of ACL laxity especially if other knee structures are intact and they have been diligent with rehabilitation. What continues to surprise me though, is when you see clear evidence that an ACL injury has actually healed.
This is Mike’s story. Mike is a 39 year old man who enjoys surfing, skating, snowboarding and gym. He is fit and strong. He had an isolated injury to his ACL skateboarding and fully expected to need ACL reconstruction. Fortunately, his surgical plans needed to be delayed to fit in a family snow trip. Lo and behold, mother nature got on with the job and healed the ligament – saving money, time and the risk of surgical complications. Whilst Mike expected to have surgery, he was willing to work at a rehab program with help from a physiotherapist, his usual gym and a five dollar ACL rehab app.
He returned to surfing, skating, successfully snowboarded and recorded the highest possible score on his International Knee Documentation Committee (IKDC – subjective form).
You can read another patient’s case study of a healed ACL injury here.