In the case of those who have experienced an anterior cruciate ligament (ACL) injury, proper treatment and recovery are very important for the health of the knee. Mark Bowen, MD, Orthopaedic Surgeon and Sports Medicine specialist with the NorthShore Orthopaedic & Spine Institute, discusses treatment options for first-time and repeated ACL injuries:

How do ACL injuries occur? In athletes, can they occur because of over-training, or is this normally caused by a hit or a fall?
ACL tears occur from an acute trauma not from overuse or overtraining. The most common mechanism is twisting of the body on a planted or highly loaded foot, deceleration or landing. In skiing, it’s twisting of the knee when the ski gets stuck and often the bindings don’t release. Contact injuries to the knee may also tear the ACL, and are frequently see with other knee ligament injuries such as the MCL.

Will an ACL injury heal without surgery?
A complete ACL tear will not heal without surgery. There are some partial tears that may result in a stable knee, but my experience is that most of them are not stable enough to play cutting sports or go onto a complete tear at a later time.

What are options for someone who has had an unsuccessful knee replacement surgery?
This depends on the underlying reason for the replacement not being successful. The answer might be different if it is stiff, unstable, painful or loose among other reasons. Typically, this requires a careful analysis of the cause so that further treatment, even possible further surgery can address this and hopefully correct the issue.

What are other alternatives to surgery? I have no pain running forward or backward, only when cutting. Is there a brace that’s able to support these types of movements?
Primarily strengthening the entire core and lower extremities, as well as activity modification to avoid cutting, twisting, pivoting activities and use of a functional ACL brace. These braces can help, but cannot be perfect in preventing giving way episodes, depending on the motions and loads applied to the knee. For people who restrict their activities to straight-ahead like swimming, biking or even jogging, a brace might not even be necessary.

I have torn the same ACL three times. For my most recent tear, I have to have two surgeries. I don’t have the time or the money for these. I’ve been fully functional in playing competitive sports. Is there another treatment option besides surgery?
Clearly, a very unfortunate and difficult situation to get you to a stable condition. While surgery may still be successful, I understand your hesitation. ACL functional bracing and rehabilitation/strengthening may allow you to participate in some activities, but I would caution you to avoid aggressive cutting and twisting sports due to the risk of further damage to your cartilage.

What would you say are future complications or issues after having multiple ACL surgeries? I am 23 years old and have been told I will have arthritis by the time I’m 40. Is there truth in this or other future problems?
Unfortunately, you are very young to have so many knee surgeries. The future is best predicted by loss of meniscus tissue, knee stability and how you treat your knee going forward in terms of impact activities. If you have had significant meniscus removed, I would strongly advise you to exercise on a bike or swim.

Learn more about ACL injuries through NorthShore’s Sports Medicine department.

You can read more of Dr. Bowen’s responses in our Knee and ACL Injuries: Treatment and Recovery chat.