Surgery vs. Physical Therapy for ACL Tears [Evidence Based Review]
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In today's video we go over: Surgery vs. Physical Therapy for ACL Tears? [Evidence Based Review]: FPF Show Episode 157
- 0:00 Introduction
- 2:52 What does rehab consist of for patients who undergo physical therapy?
- 4:52 Do ACL tears (complete) heal over time? What percentage of patients heal?
- 5:13 If the ligament is showing "continuity" or healing, does that mean it's strong?
- 6:36 Does the "cross-bracing protocol" increase the likelihood the ACL heals?
- 9:01 What does the cross-bracing protocol consist of? [Rehab protocol as well]
- 12:30 Do conservatively treated ACLs that heal re-tear at a higher rate compared to ACL reconstruction surgery?
- 16:14 What surgery is considered the goal standard that is compared against conservative management? (ACL-R)
- 20:35 Do all types of ACL sprains need surgery? Which are candidates for physical therapy and not?
- 26:29 Is conservative management an appropriate option for patients after a complete ACL tear? and do we have answers to this question?
- 31:06 Do ACL tears treated with physical therapy have better knee function and health then surgically treated ACLs?
- 36:10 Do patients get back to a higher level of function with surgery or physical therapy?
- 36:55 Do patients treated conservatively have more laxity in the knee without surgery?
- 38:03 Do patients have more longterm arthritis if you don't have ACL reconstruction surgery?
- 49:16 Are return to sport rates better with physical therapy alone or with surgery?
- 51:13 Can athletes return to pivoting sports without surgery?
- 52:22 Which sports can conservatively managed athletes return to and which do they have a harder time returning to?
- 58:01 If your patient doesn't have ACL reconstruction surgery does that increase rates of meniscus injury?
- 1:04:28 Should your patient have ACL-reconstruction surgery or not?
- 1:06:44 My favorite beginner exercises for knee pain
Who Needs an ACL?!?
- Dan Pope DPT,OCS,CSCS
Show Notes / Relevant Articles:
- FPF Mini Course - 7 Reasons Why Injuries Happen in the Gym and What to do About it
- My favorite beginner exercises for knee pain
- What Physical Therapists Need to Know About ACL Injuries
- Struggling with ACL injuries? Learn how to diagnose them!
- What Physical Therapists Need to Know About MENISCUS Injuries
- Diagnosing Meniscus Tears for Physical Therapists
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Thank you!
Dan Pope DPT, OCS, CSCS
References:
Papaleontiou A, Poupard AM, Mahajan UD, Tsantanis P. Conservative vs Surgical Treatment of Anterior Cruciate Ligament Rupture: A Systematic Review. Cureus. 2024 Mar 20;16(3):e56532. doi: 10.7759/cureus.56532. PMID: 38646275; PMCID: PMC11027445.
Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013 Jan 24;346:f232. doi: 10.1136/bmj.f232. PMID: 23349407; PMCID: PMC3553934.
Tsoukas D, Fotopoulos V, Basdekis G, Makridis KG. No difference in osteoarthritis after surgical and non-surgical treatment of ACL-injured knees after 10 years. Knee Surg Sports Traumatol Arthrosc. 2016 Sep;24(9):2953-2959. doi: 10.1007/s00167-015-3593-9. Epub 2015 Apr 9. PMID: 25854500.
Filbay SR, Dowsett M, Chaker Jomaa M, et alHealing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing ProtocolBritish Journal of Sports Medicine 2023;57:1490-1497.
Keays SL, Mellifont DB, Keays AC, Stuelcken MC, Lovell DI, Sayers MGL. Long-term Return to Sports After Anterior Cruciate Ligament Injury: Reconstruction vs No Reconstruction-A Comparison of 2 Case Series. Am J Sports Med. 2022 Mar;50(4):912-921. doi: 10.1177/03635465211073152. Epub 2022 Feb 11. PMID: 35148249.
Grindem H, Eitzen I, Moksnes H, Snyder-Mackler L, Risberg MA. A pair-matched comparison of return to pivoting sports at 1 year in anterior cruciate ligament-injured patients after a nonoperative versus an operative treatment course. Am J Sports Med. 2012 Nov;40(11):2509-16. doi: 10.1177/0363546512458424. Epub 2012 Sep 7. PMID: 22962290; PMCID: PMC3576571.
Komnos GA, Hantes MH, Kalifis G, Gkekas NK, Hante A, Menetrey J. Anterior Cruciate Ligament Tear: Individualized Indications for Non-Operative Management. J Clin Med. 2024 Oct 18;13(20):6233. doi: 10.3390/jcm13206233. PMID: 39458183; PMCID: PMC11508887.
Grindem H, Eitzen I, Engebretsen L, Snyder-Mackler L, Risberg MA. Nonsurgical or Surgical Treatment of ACL Injuries: Knee Function, Sports Participation, and Knee Reinjury: The Delaware-Oslo ACL Cohort Study. J Bone Joint Surg Am. 2014 Aug 6;96(15):1233-1241. doi: 10.2106/JBJS.M.01054. PMID: 25100769; PMCID: PMC4116562.
van der Graaff SJA, Reijman M, van Es EM, et alMeniscal procedures are not increased with delayed ACL reconstruction and rehabilitation: results from a randomised controlled trialBritish Journal of Sports Medicine 2023;57:78-82