By: Alex Des Tombe

Anterior cruciate ligament (ACL) injuries are common among athletes and physically active individuals. These injuries can be caused by a sudden change in direction, a jump or a direct blow to the knee. The ACL is one of the most important ligaments in the knee joint, responsible for preventing excessive movement and maintaining the stability of the joint. When it is injured, it can lead to instability, pain, and reduced mobility. 

The management of ACL injuries can be either operative or non-operative. Operative management involves reconstructing the ligament using a graft, usually taken from the patient’s own tissue or a donor tissue. This procedure is usually recommended for individuals with high physical demands, such as athletes, or those who have suffered a complete ACL tear. Non-operative management includes physiotherapy, bracing, and activity modification. This approach is usually recommended for individuals with partial ACL tears or those who are not physically active. 

Both operative and non-operative management approaches have their advantages and disadvantages. Operative management has been shown to lead to better short-term outcomes and improve knee stability in the long run. However, it also has a longer recovery time, is associated with higher costs, and involves a risk of complications such as infection, blood clots and nerve or blood vessel injury. On the other hand, non-operative management has a shorter recovery time, is less expensive, and involves a lower risk of complications. However, it may not provide the same level of stability and function as the surgical approach, and the risk of re-injury may be higher. 

Physiotherapy is an essential part of rehabilitation for both operative and non-operative management of ACL injuries. During the acute phase of treatment, physiotherapy aims to reduce pain and inflammation, promote healing, and restore knee range of motion. As the patient progresses through the rehabilitation program, it becomes more focused on strengthening the knee muscles, improving balance and coordination, and restoring functional activities such as running and jumping. 

In the case of operative management, physiotherapy is essential in the early stages of recovery to ensure proper healing and to minimize the risk of complications. We as physiotherapists will guide the patient through specific exercises and a graduated rehabilitation program that will progressively increase the intensity and frequency of knee exercises. We will also monitor the patient’s progress and adjust the rehabilitation program accordingly. 

For non-operative management, the focus of physiotherapy is on improving functional capacity and managing symptoms. We will work with the patient to develop a personalized rehabilitation program that includes a combination of exercises, bracing, and activity modification. The program will be designed to improve knee strength, stability, and flexibility, while also reducing pain and swelling. 

In conclusion, both operative and non-operative management options for ACL injuries have their advantages and disadvantages. However, physiotherapy is an integral part of rehabilitation in both cases and can greatly benefit the patient’s recovery. Physiotherapy can help improve knee strength, stability, and range of motion, as well as reduce pain and swelling. We play a critical role in developing personalized rehabilitation programs that are tailored to the patient’s specific needs and goals. With the right rehabilitation program and support, patients can make a successful recovery from ACL injuries and return to their desired physical activity levels.