If you’re a tiger’s fan, you’ve recently read the news of Alex Rance suffering an anterior cruciate ligament (ACL) tear, which will exclude him for the rest of the season. Sadly, this is becoming an increasingly problematic injury, particularly in the women’s AFL with approximately 9 times more ACL ruptures compared to the male competition (AFLW injury report, 2018). While alarming for the AFLW, this is not surprising to anyone familiar with ACL research, as worldwide ACL injury rates in women are generally reported between 2-8 times higher than male counterparts (Arendt et al., 1995; Shea et al., 2004). More importantly, those that do suffer an ACL tear typically assume that surgical reconstruction is mandatory, which has been reported to cost Australian hospitals a massive $75 million dollars (Janssen et al. 2011). What many people don’t realise is that surgery should not be recommended as the primary management. In fact, neither conservative (i.e., no surgery) or surgical management is superior (Frobell et al., 2013), leading to the obvious question, do you need surgery? To reconstruct or not? Like any injury, establishing your goals for sports/recreation in combination with a thorough physical and psychological assessment are paramount to directing the best course of action. In the early stages following injury, it’s crucial to minimise swelling, establish full knee extension and regain quadriceps strength via a structured exercise program (van Melick et al. 2016). This is further supported by recent evidence including over 200 athletes that found exercise immediately following ACL injury can have a positive impact on knee function, that may ultimately change the need for reconstruction (Thoma et al., 2019). So, give exercise a go and don’t feel rushed making a decision on surgery! After completing a 4-6 week exercise program, the decision regarding surgery should consider these questions:
- Are you returning to high level twisting sports? (Football, soccer, basketball, netball etc)
- Have you had several episodes of giving way or instability?
- Do you require meniscal repair?
- Have you tried conservative management?