Is ACL Surgery Necessary? When to Operate vs Rehab
Knee pain after a sudden twist, awkward landing, or sports injury can indicate ACL damage – which, depending on its severity, can be alarming. If you’ve been told you have an ACL tear, you might be wondering what comes next.
While 90% of people with ACL tears go on to have surgery, it’s not always the only option. For some, structured rehab is enough to get back to daily life. But how do you know what’s right for you?
This blog walks through ACL injury treatment options and when ACL surgery is necessary to help you make an informed decision.
What You Need to Know About ACL Injuries
The anterior cruciate ligament (ACL) is one of the key stabilisers in your knee. It helps control the forward movement and rotation of the shinbone. Most ACL tears happen during sports involving sudden stops or changes in direction, landing from a jump, or a direct impact. You might hear a pop, feel your knee give way, or notice swelling soon after.
Common signs of an ACL tear include swelling, pain, instability, and limited range of motion. An orthopaedic specialist will usually run a clinical exam and MRI to confirm the diagnosis and shape your treatment plan based on the extent of damage (if it’s a partial or full tear) and if other structures are involved.
ACL Injury Treatment Options
Not everyone with an ACL tear needs surgery. Some people recover well with non-surgical rehab, while others benefit more from reconstruction. Your ACL injury treatment option depends on your age, activity level, knee stability, and goals.
Non-Surgical Management (Rehabilitation)
Rehab involves structured physiotherapy focused on strengthening the muscles around the knee, improving balance, and restoring range of motion. Bracing may also help in the early stages. This is often a good option for people who don’t play high-impact sports or don’t have physically demanding jobs.
ACL Tear Without Surgery Recovery Time
Studies show that non-athletes can recover near-normal knee function without surgery, particularly if they’re older, less active, or have partial tears. Recovery time for ACL tears without surgery is typically around 3 to 6 months. The key to success is a guided rehabilitation program focused on strength, balance, and functional movements.
Limitations and Considerations
While rehab is effective for many, it does come with limitations. You may need to avoid high-impact or pivoting activity, including sports in the long-term. Instability or “giving way” sensations could return, especially if strength and control aren’t fully regained. Additionally, chronic instability causing damage to the cartilage and meniscus will often lead to the development of early arthritis. Continued follow-up is important to track progress and prevent future injuries.
Surgical Management (ACL Reconstruction)
ACL reconstruction surgery replaces the torn ligament using a tendon graft, usually from your hamstring, quadriceps, patellar tendon, or a donor. It’s typically recommended for young patients, those with persistent instability, high activity demands, or combined injuries.
For young athletes or people whose knees continue to give way despite rehab, surgery offers the best chance at long-term joint protection.
Pros and Cons of ACL Surgery
| Pros | Cons |
|---|---|
| Improved knee stability | Recovery takes 6 to 12 months, with ACL recovery time often closer to a year for return to sport |
| Supports return to high-level sport | Risks of surgery, including infection or graft failure |
| May reduce long-term joint damage from instability | Return to pre-injury performance isn’t guaranteed |
When is ACL surgery necessary?
A common question we hear is: Do I need surgery for an ACL tear? While surgery is most often necessary, some people are suitable for conservative management.
Consider Surgery If…
You’re young and active, especially in sports that involve jumping, pivoting, or rapid direction changes
Your knee frequently feels unstable or gives way despite rehab
You have additional injuries
Your goal is to return to sport or have a job that involves demanding physical activity
Rehab Alone is Sufficient When…
You’re less active or don’t participate in high-impact activities
Your knee feels stable after the initial recovery period
You’re older with a less physically demanding lifestyle
Making the Right Decision
Whether you’re just starting to explore ACL injury treatment options or actively deciding on your next step, having the right information matters.
Speak to Dr David Sime, an experienced and highly regarded ACL surgeon in Melbourne, to help make a decision that reflects your lifestyle, future goals, and your current condition. With expert care and the right plan, recovery is possible.