ACL Ruptures – Is there an alternative to surgical management?
It has long been assumed that once you have ruptured your ACL, it must be surgically repaired as the ACL is unable to heal on its own. As a result of this, the vast majority of people with ACL ruptures will be rushed off into the operating theater, for a costly and invasive surgical procedure.
However more recent research has challenged this assumption, with early data suggesting that the ACL does have capability to heal! What’s even more interesting is that for those who’s ACL does heal, some report SUPERIOR outcomes compared to those that don’t heal and those that have surgery! (Filbay et al 2022).
This groundbreaking ‘KANON’ trial looked at 120 participants that had ruptured their ACL and were randomised into two groups. Group 1 was exercise rehabilitation alone with the option of a delayed ACL reconstruction and group 2 was early ACL reconstruction and rehabilitation.
The trial showed that half of those who did NOT opt for a delayed surgery had MRI proof of healing. That is, ⅓ of all participants who were not randomised to early surgical intervention showed evidence of healing. This is in spite of doing nothing to aid or facilitate healing, other than exercise rehabilitation alone.
This trial is incredibly interesting and challenges the current assumptions around ACL treatment. Even if your ACL does not heal, you can still live an active life and return to sports without surgery. For many others however, surgery may still be required to achieve a full recovery and return to sports.
If we can learn anything from this trial, it is that there should be a conversation between orthopaedic specialist, physical therapist and patient around the different treatment options regarding the treatment for ACL ruptures. There should also not be a rush for surgical intervention where possible!
Finally, more research needs to be undertaken around this area so that we can further understand the potential for spontaneous healing of the ACL, which may be greater than previously considered.
If you or someone you know has recently injured their ACL, please share this with them so that they are aware of the different treatment options available to them.
Filbay, S. R., Roemer, F. W., Lohmander, L. S., Turkiewicz, A., Roos, E. M., Frobell, R. & Englund, M. (2022) Evidence of ACL Healing on MRI Following ACL Rupture Treated With Rehabilitation Alone May Be Associated With Better Patient-Reported Outcomes: A Secondary Analysis From the KANON Trial, British Journal of Sports Medicine. (57): 91-98
Written by Jack (physiotherapist)