ACL reconstruction surgery has become one of the most common elective surgical procedures in the modern times. However, like any other surgery, decision to undergo this elective procedure has never been an easy one.
There are many questions around the risks of post-surgery life but also risks of not undergoing it. Some of these are “with or without it questions” that are not easy to answer.
- Will I risk developing Arthritis after surgery or if I don’t undergo one?
- Will I be able to resume normal activities, with or without it?
- Will my condition get worse or better with time?
The indications for ACL reconstruction remain controversial till date due to different opinions by orthopedic surgeons, rehabilitation workers, and physical therapist. Thanks to the internet, though we know much about our medical condition before we visit a doctor. However, most of this information is generic in nature. It may be very difficult for an average patient to apply that information as per their own medical condition and arrive at any decision. In the end, it may leave us even more indecisive than before.
Here, we are listing few simple questions that can help you make a good decision. Note that the objective is not to tell you whether to undergo ACL surgery or not, but rather to inform how to make that decision.
1. Have you exhausted the conservative options?
Have you spent enough time and effort in undergoing physiotherapy for maybe like 5-6 months but still don’t see any signs of progress vis-à-vis the knee function and stability. Your therapist has been successful in easing down your pain but the functional stability is still a question. A failed conservative treatment is the first and foremost indication that a surgery may be required.
However, never ever think that you have just wasted these months in physiotherapy. Instead, you have prepared and made your knees stronger for a reconstruction surgery. You could think of it more like a pre-operative rehabilitation.
2. What is your body telling you?
An ACL tear, whether partial or complete, would typically result in episodic occurrences of knee instability. There is no strong correlation between the extent of the tear and the amount of instability experienced, as it varies a lot from person to person. A person with just a partial tear, which may heal on its own, may also express knee instability, whereas in some rare cases, a person with a complete tear may not report any instability issues.
Each time you experience any unstable movement such as a feeling of forward slip of your tibia (below knee joint), or an abnormal pivot or rotation of the knee, make a note of it. Over time, observe whether the stability is getting worse or improving gradually.
3. Consider your age
Age group within 20 to 40 is considered good for all reconstruction related procedures, owing to better health, and anticipated higher physical activity. The muscle strength and joint integrity at this age play an important role in postoperative healing and overall progress. Further, the need for reconstruction may not be justified in later ages as people are more likely not to engage in any risky or high-impact physical activity.
Likewise, if when a child is in growing teens, one has to consider additional risks involving the harm to the growth plates, and whether surgery could be delayed.
4. Confirm your diagnosis
An Extensive MRI Report showing damage to your ligaments does not qualify you for surgery as there are subjective variations. Though an indication for a complete tear of ACL is a strong indication, it is not sufficient by itself to undergo a surgery, especially when other indications do not match.
Go through many expert opinions; meet people who have undergone surgery to know their experience with rehabilitation. This will definitely answer your many questions, and yes ease your fear too. A more definitive indication for an ACL tear is an arthroscopic evaluation but it may not be necessary when other indications are clear enough.
5. Evaluate Your Future Needs
What future you have in mind vis-à-vis your knee function is crucial to taking a decision on ACL surgery. Are you planning on continuing with any high-impact sports? Can you switch to any low-impact activity? Does your lifestyle expose you to further chances of similar injuries? Do you need to get your knee fixed soon so you would not lose out in your sports career? The cost of surgery is also an important consideration for many.
A professional athlete who is likely to return to high-impact sports should likely consider ACL surgery, as medical evidence suggests a strong chance of further injury if the knee instability has not been taken care of. If one experiences a regular pattern of instability despite engaging in normal activities, it is a definite cause for concern.
On the other hand, a person who does not foresee any such need or participation in high-impact sports, and does not exhibit any signs of instability may think again about having an ACL surgery.
The list for decision considerations is long owing to individual variations. However, if there is profound joint laxity, instability, and proprioception loss for more than six months, then one may consider surgery as an option to improve one’s quality of life.
Moreover, remember that the recovery does not end after reconstruction surgery, but it has to be followed with an extensive physical training involving strength, flexibility, and proprioception, which refers to building awareness of how your operated knee joint is functioning.
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