The ACL: It can heal!
Hearing you have torn a ligament in your knee can be devastating news, no matter what age you may be. Whether you’re a 16 year old athlete getting ready for your upcoming sports season, or a 45 year old parent getting ready to coach your child’s soccer team, a significant knee injury may have you thinking you are destined for surgery and will miss many future events. However, recent research has looked into the body’s self healing capabilities for these injuries, and how individuals respond to treating this without surgery. For example, a recent study published this year (2022) followed a group of individuals diagnosed using an MRI with a ruptured ACL. These participants were randomized into rehabilitation alone with the option of delayed surgery in the future, or early surgery to reconstruct the torn ACL. Those patients who were randomized into the rehabilitation only group were retested again at 2 years and 5 years later, to check in on how their knee has progressed and to retake MRI’s of the affected knee joint. These authors founds that more than half of these participants had a fully healed ACL on the MRI scan at the 2 year follow up, with even more showing a healed ACL at the 5 year follow up. In addition to the healing demonstrated by the MRI scans, the patients had higher self reported knee scores on the surveys they filled out compared to those who underwent reconstruction. These findings coincide with a systematic review that was published last year, which reviewed 9 different studies of reviewing the healing abilities of the ACL following a full tear. These authors found similar results that the majority of patients who were managed non operatively with bracing, physical therapy, strengthening and range of motion exercises, showing healed ACL’s with subsequent MRI scans ranging from months to a few years following the initial injury.
In addition to the self ability to heal, recent research has also looked at patient reported outcomes for patients who have had ACL reconstruction compared to those who chose to manage their injury non operatively. This recent research suggests that patient self reported outcomes are very similar between the non-operative group and the surgical group. These successful outcomes with non-operative management should be very encouraging for individuals who may be fearful of surgery, or cannot afford the time needed for post op recovery.
If you have recently had any ligament injury to your knee, talk to your doctor about your surgical and conservative management options. Depending on your situation, it may be a good option for you to try conservative management, and seeing a skilled physical therapist to give you a rehabilitation plan that is fitted to you and will help you meet your goals. You may be able to get back to what you enjoy doing without surgery, with even good potential for your ligament to heal on its own!
Tim Breslin, SPT, Temple University Class of 2022