Do All ACL Injuries Need Surgery? Understanding Your Options

An anterior cruciate ligament (ACL) injury can be a daunting diagnosis, especially if you’re an active person or enjoy sports. But the good news is that not all ACL injuries automatically require surgery. At Joondalup Sports Medicine (JSM), we work closely with each patient to determine the most appropriate treatment based on their individual lifestyle, activity level, and goals.

Understanding the ACL and Its Role

The ACL is a key stabilising ligament in your knee, helping control rotation and forward movement of the tibia. When it’s injured—often during sudden twisting movements, landing awkwardly, or direct impact—the knee can feel unstable, swollen, or painful.

Surgical vs. Non-Surgical Management

Historically, ACL injuries were often treated with surgical reconstruction. While surgery can restore stability, it’s not always necessary. Research increasingly supports a tailored approach:

1. Non-Surgical (Conservative) Management
For many people, especially those who are less active or don’t participate in high-demand sports, physiotherapy and rehabilitation can be highly effective. A structured rehabilitation program focuses on:

• Strengthening the muscles around the knee
• Improving balance and proprioception
• Gradually returning to daily activities or low-impact sports

Studies show that with dedicated rehab, some patients achieve excellent knee stability and function without surgery. Approximately 50–60% of patients with an isolated ACL tear can return to their regular activities without needing reconstruction, provided they commit to rehab.

2. Surgical Management
Surgery may be recommended for individuals who:

• Participate in pivoting or contact sports
• Have significant knee instability despite rehab
• Have additional injuries, such as meniscus tears

ACL reconstruction involves replacing the torn ligament with a graft and requires a carefully structured post-operative rehabilitation program to restore strength and mobility.

Research Insights

• A landmark study published in the British Journal of Sports Medicine found that tailored rehabilitation alone allowed many patients to return to pre-injury activity levels, with similar long-term outcomes to those who had surgery.
• However, younger, highly active patients are more likely to benefit from surgical reconstruction if they want to return to competitive sports.

Making the Right Choice

Choosing between surgery and conservative treatment is a personal decision that depends on your activity goals, knee stability, and lifestyle. At JSM, our team of orthopaedic specialists and physiotherapists work together to provide:

• Comprehensive assessment of your knee function
• Review of imaging and test results
• Evidence-based advice on treatment options

We believe in empowering our patients with the knowledge and guidance needed to make an informed decision.

Take the Next Step
If you’ve suffered an knee injury, don’t leave your recovery to chance. Book a consultation with the JSM team today to review your options and create a personalised treatment plan that’s right for you.