ACL Tear Does Not Automatically Mean Surgery

A frequent injury we see in PA workers’ compensation cases is a tear of the anterior cruciate ligament (ACL) in the knee of the injured worker. In the past, this type of injury automatically required extensive reconstructive surgery to repair the tear. As we mentioned in a blog a few years ago, the thought process was changing to recommend rehabilitation before resorting to surgery.

Recently, the website for Andrews Institute for Orthopaedics & Sports Medicine referenced a study performed on skiers, which showed that approximately a quarter of those patients with a torn ACL can avoid surgery entirely, instead just rehabilitating the knee with physical therapy. Many sports fans are no doubt familiar with Dr. James Andrews, the head of this facility, who serves as orthopedic consultant for many college and professional sports teams.

The ACL is one of four ligaments in the knee. The others are medial collateral ligament (MCL), lateral collateral ligament (LCL) and posterior cruciate ligament (PCL). The primary function of the ACL is to prevent the shin bone from sliding out in front of the thigh bone. When this ligament is torn, the injured ACL is less able to control knee movement, and the bones are more likely to rub against each other. This can damage adjacent structures and can lead to osteoarthritis in the knee.

Since having immediate surgery for a torn ACL may expose an injured worker to an unnecessary major operation, but waiting too long can cause damage to other parts of the knee and lead to a chronic debilitating condition, there is a need for quality medical treatment in the weeks after the work injury.

How long should an injured worker wait to see if surgery will be necessary? According to Dr. Robert Marx, an orthopedic surgeon in the Sports Medicine and Shoulder Service at the Hospital for Special Surgery in New York City who led the study, unless there is damage to other ligaments or parts of the knee, an injured worker should “wait and be reevaluated at six to 12 weeks unless there is some other obvious reason to do surgery . . .”