Athletes commonly ask us, “Is it ok to wait to have ACL surgery?” I’ll start this article with a few general thoughts and reasoning on the question and then we’ll take a quick look at a research study that was conducted in the British Journal of Sports medicine tackling the exact question. Keep in mind that our thoughts are not conclusive on the topic and it’s always possible that others may disagree.
When we talk about whether or not it’s ok to wait to have ACL surgery, there are a number of factors to consider:
- The current condition of your knee and how it’s affecting your lifestyle
- Whether or not you are 100% convinced you want to pursue surgery
- If and how quickly you want to return to sport
Let’s take a look at each of these questions and how they might affect your decision making when it comes to answering the question, “Is it ok to wait to have ACL surgery?”
If your knee is in bad shape and severely limiting your lifestyle, you may think it’s best just to get surgery over with, so you can get back to 100% as fast as possible.
I get it – you are the type of person who goes THROUGH every obstacle you’ve faced in life. It’s an admirable trait. But the data (here and here) suggests you might be better off waiting to have ACL surgery.
Well, not necessarily just waiting, but rehabbing like crazy. The closer you are to 100% heading into surgery, the more likely you are to have a successful outcome and less likely you’ll be to develop arthritis down the road.
If you’re not sure HOW close you need to be to 100% before surgery, try filling out the survey here (no email address required). Once you complete the survey, grab the number in the bottom right hand corner. Compare yourself to the following from this study:
0-34: Lower 25% of people heading into ACL surgery
34-45 In better shape than 25% of people heading into ACL surgery
34-56 In better shape than 50% of people heading into ACL surgery
56+ In better shape than 75% of people heading into ACL surgery.
Our suggestion is to wait at least long enough to get yourself into the 34-56 range, assuming the physician doesn’t think there are additional risks in waiting.
There is a growing population of people who are opting to see if they can avoid surgery altogether. Based on the data, we can’t blame them. There is very little evidence that reveals there are better outcomes for those who get surgery versus those who do not.
If there’s any doubt in your mind that you WANT to get surgery, take a few months and rehab as hard as you can. If you’re not doing anything that causes the knee further damage (check with your PT or physician), the WORST you can do is put yourself in great shape for surgery (see thought #1).
Who knows – maybe you’ll convince yourself that you can eventually live your preferred lifestyle or return to sport without surgery.
If you 100% want to return to sport and are 100% convinced you need to get surgery, waiting for surgery may delay your ACL recovery timeline a bit.
For instance, it’s possible that you wait 2-3 months to have surgery and then STILL require the traditional 6-12 months of recovery time on the back end of surgery, which would bring your total time away from sport to 8-15 months.
On the other hand, if you opted for surgery right away, you may be able to keep the recovery time at 6-12 months (if all goes well with recovery).
I believe this is why many professional athletes opt for surgery as quickly as possible – playing a sport is their livelihood, and they can’t afford to wait 2-3 months “to see how things go” with the non-surgical route.
Surprisingly, the research is rather sparse on the topic. A 2017 study in the British Journal of Medicine tracked the results of 118 people with ACL ruptures for 5 years. 59 of the participants underwent early ACL reconstruction (<2 months after injury) followed by exercise therapy. The remainder were asked to try exercise therapy before surgery. Of those who tried exercise therapy before surgery, 30 opted for delayed ACL reconstruction (>2 months after injury) and 29 avoided surgery altogether. The results suggested that:
“Delaying ACL reconstruction and managing ACL rupture with exercise therapy alone may shift prognostic factors for 5-year outcomes in a positive direction.”
(This means delaying surgery may actually be a GOOD thing).
In our opinion, unless you 100% believe surgery is necessary AND need to return to sport as quickly as possible (or your doctor is telling you surgery is needed right away), delaying surgery and enrolling in an exercise program may be the way to go.
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