You may have been told that if you rupture your ACL in your knee, it cannot heal and surgery is the only option.
Would you believe me if I told you that this may not always be the case?
The studies I have listed below show success rates of fully ruptured ACL’s healing without surgery anywhere from 61% to 100% of the time! (the studies showing 100% have only 6 and 14 subjects, but still crazy to see!)
These studies show compelling evidence that a fully ruptured ACL definitely can heal on its own, and furthermore can show similar functional results as ACL surgery at shockingly high rates.
The data is definitely strong enough to definitively say that ACL surgery is definitely NOT required 100% of the time for a fully ruptured ACL. Not even close.
Your body might just be a lot more resilient than you may realize.
Below I discuss a bit more on the specifics in terms of rehab strategies and bracing protocols if you want to learn more scroll to the bottom of the page.
Here are the articles.
| Authors: Filbay et al 2022 Title: Evidence of ACL Healing on MRI following ACL rupture treated with rehabilitation alone may be associated with better patient-reported outcomes: a secondary analysis from the KANON trial Link: https://pubmed.ncbi.nlm.nih.gov/36328403/ Summary: MRI appearance of ACL healing after ACL rupture occurred in one in three adults randomised to initial rehabilitation and one in two who did not cross-over to delayed ACLR and was associated with favourable outcomes. |
| Authors: Filbay et al 2023 Title: Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol Link: https://pubmed.ncbi.nlm.nih.gov/37316199/ Summary: After management of acute ACL rupture with the CBP (Cross Bracing Protocol) , 90% (of 80) patients had evidence of healing on 3-month MRI (continuity of the ACL) |
| Authors: Ihara & Kawano 2017 Title: Influence of Age on Healing Capacity of Acute Tears of the Anterior Cruciate Ligament Based on Magnetic Resonance Imaging Assessment Link: https://pubmed.ncbi.nlm.nih.gov/28045756/ Summary: ~62% of 102 subjects showed healing of ACL 6 months post rupture without surgery, and with conservative management including bracing and rehab. |
| Authors: Costa-Paz et al 2012 Title: Spontaneous healing in complete ACL ruptures: a clinical and MRI study Link: https://pubmed.ncbi.nlm.nih.gov/21643922/ Summary: 14 out of 14 (100%) of subjects showed ACL healing at 2 year follow up and returned to their prior activity level. |
| Author: Frobel et al 2010 Title: A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears Link: https://www.nejm.org/doi/full/10.1056/NEJMoa0907797 Summary: 36 out of 59 (61%) of subjects who did rehab only did not opt for surgery. |
| Author: Previ 2023 Title: Spontaneous healing of a ruptured anterior cruciate ligament: a case series and literature review Link: https://pubmed.ncbi.nlm.nih.gov/36738386/ Summary: The magnetic resonance imaging study at 6 months revealed an end-to-end continuous anterior cruciate ligament with homogeneous signal in 6 out of 6 of the subjects. (100%) |
| Author: Fujimoto 2002 Title: Spontaneous healing of acute anterior cruciate ligament (ACL) injuries – conservative treatment using an extension block soft brace without anterior stabilization Link: https://pubmed.ncbi.nlm.nih.gov/12029510/ Summary: MRI confirmed that 21 injured ACL out of 23 knees showed ACL healing after using extension block soft brace for 2-3 month. 74% were shown to be stable at 16 month follow up. And 26% went to get ACl surgery due to instability. |
If you have torn your ACL, surgery is NOT your only option.
As of right now, experimentation is still being done in terms of what is the best route to do rehab without surgery, with the main variable being how much bracing needs to be done.
The above studies show various approaches of no bracing, bracing at 90 degrees, bracing to block full extension, or using regular hinge braces, and all of them show varying levels of success.
If you want to learn more I highly recommend following Dr. Kieran Richardson with Global Specialist Physio. He is pioneering a lot of the work on this, and seeing a lot of success with it! The brace they prefer to use is a blocked extension brace, meaning you can move the knee fully except into full extension (which theoretically helps protect the ACL to encourage realignemnt of the fibers while it heals).
Give us a call if you want to chat more to see if avoiding ACL surgery might be a good choice for you. Schedule your free Discovery Call here.
