ACL Tear: To Operate or Not When Walking Pain-Free?

You have a torn anterior cruciate ligament (ACL) in your right knee, but you do not experience pain while walking normally. You would like to know if surgery is necessary?

Hello, doctor.
I started experiencing significant leg fatigue after hiking in March, which lasted about a week.
I suspected a possible right knee sprain and went to a nearby rehabilitation clinic for an examination.
At that time, the doctor only used a reflex hammer to check my knee and confirmed that there were no abnormalities in my reflexes.
I then underwent heat therapy and electrical stimulation for a period of time.

Later, in October, as the weather turned colder, I began to feel noticeable pain extending from my knee all the way up to my calf.
I visited the hospital's rehabilitation department, where an MRI revealed a torn anterior cruciate ligament (ACL), and the doctor assessed that it seemed to have been an issue for quite some time.
I was verbally informed that surgery was inevitable, although there was a non-surgical option (PRP injection), which was not recommended due to its high cost and limited effectiveness.
I am considering whether to proceed with surgery for several reasons: 1.
For the past few months, I have been able to walk normally without severe pain, and there are no specific angles at which I cannot bend my knee.
2.
I can lightly jump in place on my right foot without pain.
3.
I feel more discomfort when going up and down stairs, especially when descending.
4.
Pain occurs during activities such as running, jumping (both feet off the ground), sudden squatting and standing, kicking, and applying pressure (like forcefully straightening my knee or pressing down on my leg).
5.
I am concerned about potential postoperative complications.
Is it possible to rehabilitate through strength training? I hope to regain my ability to run, jump, and kick without surgery negatively impacting my current quality of life.
If my situation is not urgent, I would like to gather more information before making a further decision.

Aima Luo, 20~29 year old female. Ask Date: 2020/11/02

Dr. Zhan Xian reply Orthopedics

Hello, Miss Emma Luo.
It is recommended that you bring your MRI disc to the orthopedic outpatient clinic for a physical examination and consultation.

Reply Date: 2020/11/02

More Info

When considering whether to undergo surgery for an ACL tear, especially when experiencing minimal pain during normal activities, it is essential to weigh the potential benefits and risks of surgical intervention against conservative management options.
Firstly, the anterior cruciate ligament (ACL) plays a crucial role in stabilizing the knee joint, particularly during activities that involve pivoting, jumping, or sudden changes in direction. If you are experiencing pain primarily during high-impact activities such as running, jumping, or squatting, it may indicate that your knee is not fully stable, and the risk of further injury could increase without surgical repair.
In your case, you mentioned that you can walk normally without significant pain and can perform certain movements without discomfort. This is a positive sign, as it suggests that your knee may still have some functional stability. However, the discomfort you experience when descending stairs or during high-impact activities indicates that the knee may still be compromised.
Regarding the surgical option, ACL reconstruction is generally recommended for individuals who are active and wish to return to sports or activities that require knee stability. The surgery aims to restore the knee's function and prevent further damage to the joint, including potential meniscal tears or cartilage damage. While surgery is effective for many, it is not without risks, including infection, blood clots, and the possibility of persistent pain or stiffness post-surgery.
On the other hand, conservative management, which may include physical therapy, strength training, and activity modification, can be effective for some individuals, particularly those who do not engage in high-impact sports. Strengthening the muscles around the knee can provide additional support and stability, potentially alleviating some symptoms. However, it is crucial to note that if you choose this route, you should be diligent about following a structured rehabilitation program to ensure the best outcomes.

In terms of rehabilitation, focusing on muscle endurance and strength training can significantly improve knee function. Exercises that strengthen the quadriceps, hamstrings, and calf muscles can enhance stability and reduce the risk of further injury. Additionally, proprioceptive training, which improves balance and coordination, can also be beneficial.

Ultimately, the decision to proceed with surgery should be made in consultation with an orthopedic surgeon who specializes in sports medicine. They can provide a thorough evaluation of your knee and discuss the potential outcomes of both surgical and non-surgical options based on your specific circumstances and activity level.
If you are not experiencing significant pain during daily activities and can manage discomfort with conservative measures, it may be reasonable to delay surgery and focus on rehabilitation. However, if your goal is to return to high-impact sports, surgical intervention may be the more appropriate choice to ensure long-term knee stability and function.

In conclusion, the decision to operate or not on an ACL tear when walking pain-free involves careful consideration of your lifestyle, activity level, and the potential risks and benefits of surgery versus conservative management. Engaging in a thorough discussion with your healthcare provider will help you make an informed decision that aligns with your personal goals and needs.

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