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Harvard Medical School
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General Medical Questions
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Question : Is there another option besides surgery to repair a complete ACL tear?
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The Trusted Source
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Howard LeWine, M.D.

Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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April 22, 2014
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The anterior cruciate ligament (ACL) gives your knee major stability.  It keeps the bones that make up the joint (the femur above and the tibia below) in proper position. So it prevents them from slipping forward or back. Additional ligaments serve similar functions, preventing the bones from slipping forward, back or side to side. 

When you think about the stresses we put on our knees with everyday use and exercise, it’s a good thing we have such an elaborate and reliable system of stabilizers!

Unfortunately, you can’t repair a complete tear of the ACL with medicine. Or just some time passing by. But not everyone with a torn ACL is a good candidate for surgery. And some people who are good candidates decide not to have it.

For instance, people who don’t put much stress on the joint (such as those who are sedentary) may do well without surgery. And for some people, physical therapy along with a knee brace and/or cane can give a measure of stability that is “good enough.” I have seen a number of patients with ACL tears who chose not to have surgery.   

But there appears to be a higher risk of cartilage damage (meniscal tear), chronic pain and reduced function in people with an untreated ACL tear. There is also a higher risk of degenerative arthritis.  But that’s true with or without surgery.  

That said, surgery might be appropriate if you have a complete tear of the ACL and you are physically active. Or you are bothered by symptoms of instability. That is, the knee feels like it is “giving way” or “giving out.”

Surgery is even more appropriate if you have additional injuries (such as torn cartilage) along with your ACL tear.

The good news is that the surgery is highly successful. It’s relatively noninvasive. And it can usually be done arthroscopically. The surgeon operates using small incisions instead of one larger incision. That means recovery time is fairly short, too.

 

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