Does an ACL tear need surgery?
This week a 16-year-old girl came into the office with a torn ACL. Wow, what a devastating injury to have. Her initial reaction was to say that she wanted to continue her sport while wearing a brace. She knew that there were braces for knees after an ACL tear and she wanted to know why she could not wear the brace and delay having surgery. Good question! Why is the surgeon so anxious to recommend surgery for an ACL tear? Why not apply a brace and let the athlete continue the sport until there is a convenient time to do surgery?
First of all, let’s get some facts straight about ACL tears. Once the ACL is torn it does not heal itself. A knee without a functioning ACL becomes unstable. The knee can give way unexpectedly, sometimes during sport activities or while walking around. A brace is designed to help prevent giving way of the knee after a tear. (It will not prevent a tear.)
This is the problem. When the knee gives way, it is painful often resulting in having to stop play for several days. In addition when the knee gives way, it could cause injury to other structures in the knee. This is especially true for the cartilage of the knee, both the meniscus cartilage between the knee and the hyaline cartilage that covers the ends of the bone. If these are injured, damaged or torn, they don’t heal themselves just like the ACL. Once the cartilage is damaged, it is inevitable that arthritis will develop. It can take 15-20 years to become symptomatic. Many younger adults can’t relate to that time frame, but us more mature (older) folks know that an arthritic knee at 30-35 years of age is a real problem. That is the age that we require good health and mobility to provide for and raise a family. Additionally most 30-35 year olds are still very active.
That is why orthopedic surgeons recommend ACL surgery for injured patients. We are trying to protect the knee from permanent damage.