Q. I am 35 year old recreational athlete who enjoys skiing and basketball. I was recently diagnosed with a torn anterior cruciate ligament (ACL) after a skiing injury. My orthopaedic surgeon said this can be treated either with or without surgery. Which is the better choice?

A. Anterior cruciate ligament injuries are a very serious problem for athletes and active individuals. The anterior cruciate ligament is a very important stabilizing ligament of the knee and once it is torn you are prone to a “trick knee”, one that is prone to shift out of place or buckle on you especially with running cutting activities and certain sports.

The treatment of anterior cruciate ligament injuries can vary from non-surgical (rehabilitation, bracing, and activity modification) to reconstructive surgery. In my opinion, the younger and more active you are, the more likely you will need reconstructive surgery. The older and more sedentary, the less likely. If you enjoy sports that place high demands on the knee and require sudden change in direction, you would probably be best served with anterior cruciate ligament reconstruction. 

Fortunately, the techniques have gotten much better and require minimal incisions. The recovery and rehabilitation is also much faster. What was once a career ending injury for serious athletes is now usually is just a season ending injury which means that they can usually get back to their sport or favorite activity in approximately 6 months. Once the anterior cruciate ligament is torn, it usually cannot be sewn back together. Instead it is replaced by a new tendon or ligament.

If you decide to go ahead with surgery you will need to choose between a donor tendon or ligament (allograft) or the use of your own tissue (autograft). Each has its advantages or disadvantages. I prefer an accelerated rehabilitation program in which physical therapy, full motion and full weight bearing are started immediately and there is no need for a brace.

Patients are usually off crutches within a week. You are back in the gym, stationery cycling, lifting and swimming in 1 to 2 weeks. Even though you might feel great within a month or two, we do not allow you to “test drive” your new ligament in a competitive sports situation for approximately 6 months. This is because your body requires that much time to fully incorporate the new ligament into your knee in its new home.