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Acute ACL Tear- Is it safe to try physical therapy first?

A recent study in the British Medical Journal in January 2013  study compared early acute Anterior Cruciate Ligament (ACL) Reconstruction surgery followed by physical therapy and another group who had just Rehabilitation Only (RO) followed by an acute ACL injury with the option of having surgery during the term of the study.  Both groups were followed for five years.  The results of study were as follows:
 

  • No difference in patients reported outcomes between groups at 5 years
  • No difference in the degree of Osteoarthritis (OA)  in both groups
  • ACL Surgery group noted earlier stability that RO group
  • Greater number of patients requiring Meniscal surgery in RO group

 
This study was not conducted on professional athletes or only moderately active individuals so the findings should to these two groups until more research is done.    The specific ACL reconstructive surgeries included both patella tendon and hamstring grafts of single bundle type of reconstruction.  In recent years the technique used to reconstruct the ACL surgery that did not completely replicate the original  anatomy of the torn ACL.  That being said the double bundle approach, being used by more progressive surgeons may improve the outcomes in regards to developing osteoarthritis and overall patient satisfaction.
At this time I would opt for rehabilitation with the option of surgery more for lack of stability and pain after a minimum of 4-6 months.
 

Tom Willemann

Tom Willemann

Tom Willemann is a premier physical therapist based out of Bergen County, New Jersey. He holds an MS in physical therapy from the University of Miami, is credentialed in the world-renowned McKenzie Method of Mechanical Diagnosis and Therapy (MDT), and holds an OCS (Orthopedic Clinical Specialist) certification. As of 2018, there are approximately 14,000 ABPTS certified specialists in the nation and less than 400 of them are located in the state of New Jersey. Tom is the owner and director of Apex Orthopedic Rehabilitation in Paramus. He opened the clinic, which specializes in spine and sports injury prevention, in 2004 after many years of experience in the field. Tom’s caring interest in others and his strong belief in continuity of care, combined with his clinic’s ability to find solutions for the most difficult orthopedic problems, have earned Apex Orthopedic Rehabilitation its excellent reputation with patients and medical professionals in northeastern New Jersey and beyond. A true “family man,” Tom takes pride in his clinic’s warm and welcoming environment.
Tom Willemann

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