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Sports Medicine

Near Complete ACL Tear from Femoral Portion

12/08/2010

Question:

Around a week ago I injured my knee while playing soccer. I went to a doctor and it turned out to be an ACL injury.

The doctor told me to get an MRI, and the MRI revealed "near complete tear of the ACL from the femoral portion, bone contusion involving lateral femoral and bilateral tibial condyles and mild to moderate retro and suprapatellar synovial effusion.” The other ligaments are not injured and I can walk now. The doctor gave me some medicine which helped with the swelling.

There is no pain now and the doctor suggested surgery, what do you suggest? Should I go in for a surgery or should I go for a non-surgical method and use a good knee brace? I am a 22 year old male.

Answer:

There are pros and cons regarding surgical vs. nonsurgical treatment following an ACL (anterior cruciate ligament) injury.

This decision needs to take into account:
  • Any associated injuries (for ex., to the meniscus or articular cartilage) 
  • Whether a person has generalized joint laxity 
  • The integrity of the injured knee's "secondary restraints" (with the ACL considered a "primary restraint" to excessive joint play/looseness)
  • Activity levels before and desired activity levels following the knee injury (including exercise, sports, vocational and avocational activities), among multiple other variables.
A well-fitting and appropriately designed ACL knee brace may help control knee pain and joint instability symptoms, but will not necessarily prevent re-injury or a new injury.

Strengthening, overall conditioning/reconditioning, balance and agility training and technique training emphasizing optimal force absorption (improving one's ability to control deceleration) are all necessary regardless of whether surgery or non-surgical treatment is decided upon.

Also, surgery doesn't necessarily prevent the development of knee osteoarthritis 10-15 years following an ACL injury.

All of the above needs to be discussed in detail with your surgeon and if this discussion is not satisfactory to you, consider getting a second opinion.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University