Okay, so you have been informed by your orthopedic doctor that you have suffered from an ACL tear. Let’s assume you have been advised to undergo an ACL surgery.
How would you go about deciding whether to go ahead or not? Whether it be a minor surgery or a major one, deciding to undergo any surgery is not easy. The fact that you are already stressed out and cannot think about it with a clear head makes it all the more difficult.
So, here are few simple pointers to make an intelligent and informed decision about it.
1. Never Rush
An ACL Injury, howsoever bad, or even a complete tear does not warrant an immediate corrective surgery. As long as you keep yourself away from getting injured again, and do not stress your knees further, it is completely safe to wait weeks and even months before you decide to go under the knife. If you come across a health worker or specialist who seems to be rushing you into making a decision, take a breather and politely excuse yourself.
2. Exhaust Conservative Approaches
There is a lot of conflicting medical evidence for and against using an ACL surgery as an intervention for handling ACL tear. However, the golden rule that if it ain’t’ break; don’t fix it still holds true. How do you know that your ACL is so torn that only surgery can fix it? None of the routine tests including the MRI and clinical examination is a full-proof mechanism to determine that you have such a bad ACL tear that nothing but surgery can fix.
Have you given enough effort to recuperate from the injury by undergoing physiotherapy under an expert supervision? It may be wise to give at least few months with regular physiotherapy and exercise and record the symptoms with regards to stability of the knee.
If it turns out that the routine physiotherapy and exercise is improving your knee function, you can probably skip the surgery altogether.
3. Watch Your Symptoms
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.
4. Confirm your diagnosis
Use a combination of clinical examinations, MRI report and awareness of your knee stability to zero on the fact that you may be suffering from a serious ACL tear.
Relying on one indication alone is prone to error because MRI report and even a clinical examination carried out by an expert can be in error. [1, 2, 3]
The benefit of combining multiple inputs can help by reducing the error chances. If the MRI report, clinical examinations, and your knee stability experiences do not match, you need to assess further if you have a real strong case to undergo an ACL surgery.
5. Evaluate Your Future Needs after ACL surgery
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 may be better off undergoing the 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 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.
While the above list is not an exhaustive list of points to consider before a decision is made, a detailed pros and cons analysis that is specific to your medical condition can lead to a much better decision on not only whether you should undergo an ACL surgery, but also of what type. There is a lot of content available in the internet that can help raise awareness. However, what is most lacking is the guidance on how relevant the information is as per one’s specific medical case. That is where a guidance provided by independent and unbiased medical experts who want you to take the best decision can be most helpful.
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Dr. Kaleem Mohammed graduated as a Bachelor of Physiotherapy in 2014 from Deccan College of Physiotherapy, affiliated to Dr. N.T.R. University of Health Sciences, Vijayawada, India. Dr. Kaleem is an expert at handling physiotherapy needs of patients suffering from orthopedic and spinal conditions and post-surgery rehabilitation. Dr. Kaleem is associated with HealthClues since its inception where he facilitates diagnosis and advanced consultation with senior doctors. He is also a medical researcher and prolific writer who loves sharing insightful commentaries and useful tips to educate the patient community about fitness, treatment options, and post-treatment recovery.