Do I Need to Get Surgery On My Torn ACL?

Mar 3, 2014
Outside Magazine

How should you treat an ACL injury?    Photo: Getty Images/iStockphoto


An ACL tear is an athlete’s worst nightmare. One of the knee’s main stabilizers, the ACL keeps you upright when you plant and pivot. Reconstructive surgery and months of recovery often follow ACL tears.

Yet a new study suggests that surgery isn’t required for almost 25 percent of first-time, skiing-induced ACL injuries.

“It is unclear why, but this phenomenon is unique to recreational skiers,” says Dr. Robert Marx, M.D., professor of orthopedic surgery at the Hospital for Special Surgery in New York City and author of the study.

The reason might have something to do with skiing, says Steven B. Singleton, M.D., FACS, founding partner of the Steadman Hawkins Clinic of the Carolinas. Because many recreational skiers injure themselves at lower speeds, the force of the energy transfer through the knee often leads only to partial ACL tears, which can sometimes heal on their own. Beyond the force of impact, the fixed position of the ankle and foot within the ski boot might help minimize tears, says the study's co-author, Dr. Demetris Delos.

Researchers for the study compiled the medical records of 63 recreational skiers with acute, first-time ACL tears. Of that number, 29 chose to skip surgery. On follow-up visits six to eight weeks later, 17 performed positively on tests, potentially indicating an ACL that was healing itself.

Two years later, out of the 11 patients who were still seeing Dr. Marx, 10 had maintained positive scores, indicating a healed ACL, and eight continued to ski recreationally, without the use of a brace.

“Not all heal,” writes Marx. “If [they don’t], they may require surgery.”

But reconstructive surgery isn’t a surefire solution to future ACL integrity. According to the American Academy of Orthopedic Surgeons, surgery is successful in the long-term between eighty-two and ninety-five percent of the time.

The bottom line: Patience, young grasshopper. If you’re a recreational skier and this is the first time you’ve injured your ACL, ask your doctor if you should wait before scheduling surgery. A minor tear might heal itself.

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