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Life without the ACL

Most people who are faced with the decision of whether or not to have ACL surgery want to know what life would be like if they were to never have their ACL fixed. There are a lot of people out there who have had an ACL injury, decided not to have surgery, and are leading very normal lives. There are others who didn't have the surgery but have given up some activities that they felt they could do without. This decision is really all about the types of activities that you want to be able to do versus the types of activities that your knee will let you do without giving out. Age used to be more of a factor in deciding between surgical and non-surgical treatment of ACL injuries. However, in the last ten years, the techniques for ACL surgery and rehabilitation have improved. As a result, activity level is now a much more important factor than age. Under current thinking, if you feel you could do more if you knee were more solid, your age need not necessarily be a barrier to surgery.

Because ACL surgery is an elective procedure, you can wait and see how your knee functions after an ACL tear before deciding to have surgery. Although there are exceptions to this rule, most people with a torn ACL can safely swim, hike, bicycle, and do other similar activities without doing further damage to their knee. Recreational basketball, doubles tennis, and skiing, carry a bit more risk of further knee damage or frequent episodes of the knee giving out. Sports that involve a lot of jumping, starting and stopping and changing direction quickly like soccer, competitive basketball, and athletic singles-tennis have a much higher risk of causing further damage.

If you are having a hard time deciding between having surgery and not having surgery, putting yourself on this graph of knee looseness versus activity level can sometimes make the decision more clear.

This graph illustrates the fact that the decision of whether or not to have ACL surgery is unique to each individual. After an ACL injury, each patient will have a unique combination of knee "looseness" and the desire to return to certain activities that require a strong and stable knee. As the amount of activity increases, the relative amount of looseness that the knee can tolerate decreases. This graph illustrates that some activities, to the left of the yellow line, can be performed safely after an ACL injury, whereas some activities, to the right of the yellow line, are more likely to require an ACL reconstruction if these sports are to be played safely. Most people are right in the middle, able to tolerate certain sports, like jogging and bicycling, but unable to ski competitively or play soccer. For these individuals, the decision of whether or not to have ACL surgery should be discussed in depth with an orthopedic surgeon.

 

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