After 12 years doing ACL reconstructive surgery this is still a difficult question for me to answer. It sounds logical. Something is broken – get it fixed. But it is not that simple. There is no doubt that there is a lot of hassle involved. On average a patient involved in physical work will be off for 3 months. Rehab will last for 6 months at least and then there is a commitment to continue a programme to maintain the strength in the knee.
What is gained by a reconstruction?
Definitely in 80% of patients the knee will feel more stable. You could argue with an intensive physio programme a lot of people would achieve this stability anyhow. It may protect the knee from further injury by preventing the knee from giving way. Against this is that patients after ACL surgery have double the chance of a meniscus injury than people who have not injured their ACL.
So does surgery reduce the risk of osteoarthritis?
Possibly is about all we can say. It reduces giving way and helps knee kinematics but kinematics are not normal after surgery. Patients who tear their ACLs have an increased risk of arthritis whether they have surgery or not. Of course we cannot even agree on what osteoarthritis is. Is it when the x-ray shows it or when the patient’s symptoms are at a certain level? And how do we measure it. Not very well it seems. Patients’ symptoms bear a poor relationship to their x-rays.
So should I get my ACL reconstructed?
If you want to play sport at a high level then the answer is yes. Be aware though that there is an argument that says that if you want to reduce the risk of further injury you might think of calling it a day.
I cannot dismiss the psychological value of ACL surgery. If it is broken fix it. I can understand that a lot of patients want this certainty in their lives.
So the answer is get as much relevant information as you need, discuss it with those that had it done (but don’t take everything to heart), talk to your surgeon and make full use of your consultation. Then make your mind up. Take some time to do this if you need it. There is no great rush.