PhysioWorks News & Tips: Is ACL Regeneration Possible? What You Need to Know About Healing After Injury!

ACL injury - surgery, and other alternatives for managing ACL injury?

It's every athlete's, coach's and supporter's worst nightmare - an injury to the anterior cruciate ligament (ACL) in your knee. It gets a disproportionate amount of media headlines, but with good reason. A tear of your ACL is often very painful, has a long recovery period, and what can be an uncertain outcome no matter which form of management (surgical or non-surgical) you choose.

Good management of your ACL injury is integral to your final result. There are a number of considerations that help to guide what direction you might take in your recovery, including:

1. Type of injury

Is it an isolated ACL injury, or are there other structures involved? Sometimes there has to be a certain "healing order" to things. For instance, a concurrent injury to your medial collateral ligament (MCL) will heal itself, but needs to be given time to heal before any other intervention. Isolated ACL injuries may be able to heal themselves - read on below for more information.

2. Sporting, life and occupational demands

What is it you want to get back to? Higher demand sports such as tennis or football, lower demand activities such as cycling and walking, or a fairly sedentary lifestyle? Generally, if you desired a return to high demand sports with frequent angle changes, you do better with an intact ACL. Lower demand sports and lifestyle may do just fine without an intact ACL.

3. Instability

We see that some people are "copers", and can still get around quite happily without an ACL. Others continue to feel unstable with giving way of the knee. Rehab exercises can help to improve muscular control of your knee, but continued instability episodes may point you towards surgical intervention or bracing.

4. Preference

Regardless of the intervention, results can be similar with good rehabilitation. Ideally your team of health professionals helps you match up your injury, preferences and ideal treatment options.

Let's explore, in brief, what some of your options are.

Treatment Options for ACL Injuries:

Early Surgical Reconstruction: Swift surgical intervention. This may be recommended in rarer cases, usually where a secondary injury requires early surgical intervention. An ACL reconstruction is performed at the same time as the other surgery in order to save multiple surgeries. Elite athletes may also choose an earlier surgery in order to return to sport as soon as possible.
Delayed Surgical Reconstruction after 3 Months of Rehabilitation: A surgical approach following a period of (p)rehabilitation. Current evidence indicates that delaying the decision on any surgical intervention until three months of rehabilitation can lead to better long-term outcomes, particularly for recreationally active individuals (Grindem et al., 2014). Before surgery, we are looking for a "quiet" knee, with good return of strength, stability, range of movement, and minimal joint swelling.
Non-Surgical Management: A non-invasive approach. Traditionally, this looked like an exercise program to help build strength control through the lower limb and trunk. Recently, researchers using the Cross Brace Protocol have found that a large proportion of selected ACL injuries can regenerate without the need for surgery. Researchers Filbay et al (2023) demonstrated that with a supervised period of knee bracing initially with the knee locked at 90 degrees for four weeks, then gradually opened up up to twelve week's post bracing, participants could re-grow their ACL to full (50%) or partial (40%) thickness. They had similar outcomes in return to sport, and re-rupture rates. However, a portion of participants did not demonstrate regeneration, and those that did have a partial thickness ligament did have a higher re-rupture rate.

Who Helps Your Decision?

Your Physiotherapist, GP, Orthopaedic Specialist and yourself should discuss all options available to develop a comprehensive rehabilitation and recovery plan.

At PhysioWorks, our Physiotherapists and Exercise Physiologists offer personalised prehabilitation and rehabilitation programs tailored to your sport and injury. Book your appointment today to start your rehab journey.