Guidelines for Considering ACL/Meniscus Surgery

author : AMSSM

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Any athlete who is facing the potential for an ACL repair surgery should ask himself or herself what they are hoping to do in the future.

Member Question

Would there be a set of guidelines to consider to either ‘opt-in’ or ‘opt out’ of this type of surgery, rehab and the ability to train in the future?

By Dr. Christopher Gee, MD
Member AMSSM

This is a fairly difficult question to answer for every athlete in every scenario.  The truth is, it depends on a number of factors and what the particular athlete is looking to do in the future and how much time and effort they are willing to invest in their rehab.  Typically, the ACL is torn during a twisting or rotational type of mechanism that overloads the tensile strength of the ligament.  When the ligament gives way, the entire knee shifts and causes bruising of the bone ends and potentially tears cartilage or menisci.  These injuries are often what cause the initial pain that patients experience.  Interestingly, many patients will feel better once the initial swelling and bruising has resolved.  They are able to walk and even run straight on even surfaces.  However, it is when they try to cut or pivot that the ACL deficient knee gives way and the swelling and pain return.  This repetitive shifting of the joint can lead to early arthritis.  It is for these reasons that most active young people elect to have the ACL repaired.  An ACL repair will allow for more knee stability and potentially less long-term risk of arthritis.  Yet, there is no guarantee that the knee will feel 100% normal after surgery.  There may be some postoperative pain and some limited motion, but most patients are able to get back to full activity. 

There are some high level athletes that have chosen to not have the ACL repaired and have ultimately done quite well.  This requires a high level of diligence in keeping hamstrings strong and balancing the knee musculature.  In addition, they will use a knee brace during many cutting or pivoting activities.  

Any athlete who is facing the potential for an ACL repair surgery should ask himself or herself what they are hoping to do in the future.  Straight running is usually not very demanding on the ACL, but cutting activities (like basketball, skiing, or soccer) require an intact ACL to be highly effective.  In addition, associated ligament or cartilage injuries (ie, meniscus tear) may further destabilize the knee and make an ACL repair the best option.  The risks of surgery (including anesthesia, pain and infection) must be considered against the athletic goals of the patient.  For many athletes, the balance tips in favor of surgery, but each person has their own risks (ie, associated medical problems) that may make the risk not worth the surgery.

Athletes should have a thorough discussion of the risks and benefits with their doctor and friends to make a personal decision that is best for them.  Most will decide to go forward with surgery, but this is not always as clear cut as it may initially seem.

Dr. Christopher Gee, MD
Emergency Medicine and Sports Medicine
University of Utah

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date: October 20, 2014