ACL injuries are common in sports, but surgery isn’t always necessary for recovery. The anterior cruciate ligament (ACL) plays a vital role in stabilising the knee, and a rupture can sideline athletes and active individuals. In Australia, where ACL reconstruction is the norm, about 90% of people with ACL tears opt for surgery. However, new research suggests that surgery may not be required for everyone.

While ACL surgery has been the standard treatment for decades, studies are showing that rehabilitation alone can be just as effective for many people. A significant trial published in the New England Journal of Medicine in 2009 compared early surgery with rehabilitation in young, active adults. After five years, knee function was similar in both groups, and more than half of those who opted for rehabilitation didn’t require surgery.

Further studies support these findings. One study published in 2023 found that one in three patients who underwent rehabilitation alone showed signs of ACL healing on an MRI after two years. These patients also reported a better quality of life compared to those whose ACLs did not heal.

Regardless of whether surgery is chosen, rehabilitation remains essential. This typically involves at least nine months of strengthening exercises, agility drills, and dynamic movements under the supervision of a physiotherapist. Even those who begin with rehabilitation can later opt for surgery if their knee remains unstable or they struggle to return to sports.

For elite athletes, surgery often offers a more predictable recovery timeline, which is why many choose it to return to sport more quickly. However, even after surgery, the risk of re-injury remains high. Delaying a return to sport for at least nine months can reduce the risk of re-injury by more than 50%.

Surgery has also long been thought to reduce the risk of knee osteoarthritis, a common consequence of ACL injuries. However recent studies have shown that surgery does not significantly lower the risk of osteoarthritis in the long term compared to non-surgical treatments.

Researchers are also exploring the option of knee braces. A recent study involving knee braces showed that 90% of participants had signs of ACL healing after 12 weeks. While promising, more research is needed to determine whether this method can offer results comparable to surgery.

If you sustain an ACL injury, it’s important to seek a professional assessment from a physiotherapist or an orthopaedic surgeon. They can help you understand your treatment options and discuss whether surgery is truly necessary. Many people are unaware that surgery isn’t always required, and rehabilitation may be an effective first step.

Preventing ACL injuries is also crucial. Research shows that more than half of ACL injuries can be prevented by performing specific exercises that strengthen the muscles around the knee, improve movement control, and enhance landing techniques. Prevention should always be the first line of defence.