Embracing the Conservative Approach: Rehabilitating a Ruptured ACL Without Surgery in Sports

When it comes to an anterior cruciate ligament (ACL) rupture in sports, the traditional approach has often
been surgical intervention. However, recent research studies have shed light on the effectiveness of a
conservative approach, suggesting that surgery may not always be necessary.

In this blog, we will explore the reasons why surgery does not have to be the default option for an ACL rupture and delve into the conservative approach to rehabilitating this injury, while highlighting research articles that compare results between operative and non-operative groups.

The landscape of ACL rupture treatment has evolved significantly over the past decade. Previously, surgical intervention was the gold standard for managing ACL tears, primarily due to the belief that it would guarantee a quicker return to sports and prevent long-term complications. However, emerging evidence has challenged this notion and indicated that non-operative treatment can yield comparable outcomes. Research studies have provided valuable insights into the effectiveness of the conservative approach to rehabilitating a ruptured ACL, when compared to surgical intervention.

In a landmark study by Frobell et al. (2010), researchers compared surgical and non-operative treatment for acute ACL tears. Their findings revealed that there were no significant differences between the two groups in terms of symptoms, function, or quality of life two years post-injury. Importantly, individuals who received conservative treatment displayed a lower incidence of complications and a reduced risk of osteoarthritis. Monk et al., (2016), conducted a study to investigate the outcomes of operative versus non-operative treatment in active individuals with chronic ACL deficiency. Their results demonstrated no differences in stability, symptoms, or knee function between the two groups. Furthermore, they observed a higher rate of complications in the operative group.

The long-term outcomes of ACL rupture management were explored by Filbay et al. (2017). Their study concluded that non-operative treatment resulted in similar patient-reported outcomes and knee function as surgical intervention. Notably, non-operative patients exhibited fewer post-treatment osteoarthritis changes, further supporting the conservative approach.

Based on these research findings, a comprehensive rehabilitation program is recommended for individuals with a ruptured ACL. The protocol typically includes rehabilitation to optimise knee function and reduce swelling, followed by an intensive physical therapy program. This program focuses on improving muscle strength, stability, and neuromuscular control through exercises such as closed kinetic chain exercises, proprioception drills, and plyometrics. Functional knee braces may be used during rehabilitation to provide additional stability and support. The progression of rehabilitation should be guided by specific return to play criteria rather than relying solely on a set timeframe, ensuring that athletes regain optimal knee function, strength, and stability before returning to their respective sports.

The conservative approach to rehabilitating a ruptured ACL in sports has gained substantial support in recent years, thanks to research studies comparing surgical and non-operative treatment. These studies have consistently shown that non-operative treatment can yield similar outcomes to surgery while offering benefits such as lower complication rates and reduced long-term osteoarthritis risk. By following a comprehensive rehabilitation program, athletes can achieve optimal knee function, strength, and stability without the need for surgical intervention.

At Invigorate Health and Performance, we have guided numerous athletes back to sport through a conservative, non-operative management approach after suffering an ACL rupture and opting to avoid surgery. If you have recently injured your ACL and are unsure what your next step should be, get in touch with us today and begin your rehab journey on the right track.

Written by Nicholas Dimos (Physiotherapist)