Immediately after the injury, management consists of RICE: rest, ice, compression, and elevation (RICE) of the affected knee.

Once an accurate diagnosis has been made then the doctor and patient can move forward with treatment options. Although surgery is sometimes necessary, not everyone who has an ACL injury is a candidate for surgery.

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Who should have ACL surgery?

The decision to have ACL surgery depends on many factors, including the patient’s age, activity level, and other injuries.

    Age. While there is no age cut-off for surgical intervention, it is rarely performed on individuals over age 55.

    Activity level. Surgical reconstruction may also benefit young people and those who participate in occupations or sports that involve jumping, pivoting, cutting, or rapid deceleration.

    Associated injuries. Patients with multiple knee injuries (ACL plus meniscus, fracture, or medial collateral ligament) generally benefit from surgery to prevent significant activity restrictions and minimize the already heightened risk of osteoarthritis.

While the risk of osteoarthritis is increased after an ACL tear, the effect of surgery on the development of osteoarthritis remains unclear.

Who might not need ACL surgery?

Active individuals who plan to engage in activities or sports that don't involve sudden stops or turns, such as cycling and swimming, and those who do not have knee instability in their daily lives may be candidates for a trial of non-surgical treatment with an experienced physical therapist to maximize strength, balance, and proprioception (body positioning).

Partial ACL tears are usually managed conservatively with a range of motion, strengthening, and addressing proper biomechanics by an experienced physical therapist. Return to sport is generally appropriate once the athlete has achieved strength and motion comparable to the non-injured knee. If instability develops, further evaluation is warranted.

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