Do You Always Need Surgery After an ACL Injury?
An ACL injury or tear is one of the most feared knee injuries in active individuals and professional sports athletes. Many people assume that ACL surgery is always necessary or the best option, but that may not actually be true. In reality, not everyone with an ACL tear following an injury needs surgery, and for some people, non-surgical rehabilitation can be just as effective.
In this blog post, we’ll break down:
What the ACL does.
When surgery is recommended.
When you might avoid surgery.
How physiotherapy plays a key role in recovery.
What Is the Anterior Cruciate Ligament (ACL) and Why Is It Important?
The ACL is one of the main stabilising ligaments in your knee. It helps control:
Forward movement of the shin bone.
Rotational stability during twisting, pivoting, and cutting movements.
ACL injuries commonly occur during:
Football, American Football, Netball, Basketball
Skiing, Snowboarding, Ice Skating
Sudden stopping or changes of direction
Sharp push off from standing positions
Is ACL Surgery Always Required?
The short answer is No - ACL surgery is not always required for many individuals.
While surgery is common, especially in professional athletes, research has shown that many people can function well without an ACL, provided they complete a structured rehabilitation plan. The decision whether to have surgery or not depends on several key factors, not just the scan (MRI) result.
When ACL Surgery Is Often Recommended
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Sports that involve sharp acceleration and deceleration, jumping, or rapid direction changes place higher demands on the knee.
Examples:
Football / Soccer
Netball
Basketball
Rugby
For these athletes, surgery may often provide better long-term knee stability and support.
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If your knee:
“Gives way”
Often “buckles” during daily or sporting activities.
Feels unstable despite rehabilitation or strengthening.
Surgery may be the best option to restore confidence and improve functional ability.
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ACL tears often occur alongside:
Meniscus tears
Cartilage damage
Other ligament injuries
In these cases, surgery may protect the knee from further damage.
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Recreational, amateur to high level athletes aiming to return to competitive or elite sport often choose surgery to maximise stability and improve overall performance.
When You Might Not Need ACL Surgery
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If you don’t regularly pivot, jump, or change direction quickly, your knee may cope well without an ACL surgery.
Examples:
Gym training
Cycling
Swimming
Straight-line running
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Some people become “ACL copers” - they regain excellent knee control through strength, movement training, and neuromuscular rehab.
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Non-surgical ACL rehab requires:
Progressive strength training
Balance and control exercises
Gradual exposure to activity
Range of movement training
Patience and dedication
Done properly, outcomes can be excellent.
What Does Non-Surgical ACL Rehab Involve?
Physiotherapy & Treatment focus on:
Reducing swelling and pain
Restoring knee range of motion (flexion and extension)
Building quadriceps and hamstring, gluteus and core strength
Improving hip and core control/balance
Training movement patterns to protect the knee
Hip and Knee alignment training
Conclusion: So, Do You Always Need Surgery After an ACL Tear?
No necessarily.
ACL surgery is not mandatory for everyone. Many people return to full activity without surgery when rehab is tailored and progressed appropriately.
A thorough assessment by a sports Physiotherapist or orthopaedic specialist can help you make the right decision.
The best choice depends on:
Your sport and activity level
Knee stability and overall knee health
Associated injuries
Personal goals
You only participate in straight-line activities (cycling, swimming, running).
Committed to strengthening and movement training for a longer period of time with self-management long-term.
