Nonsurgical ACL Tear or Injury Treatment

ACL injuries don't always need surgery. When people have minor ACL injuries, doctors may suggest a nonsurgical ACL injury treatment. Nonsurgical approaches may also be best for older adults and people at a higher risk of surgery complications.

UPMC specializes in both nonsurgical and surgical care for ACL injuries. By understanding your symptoms, lifestyle, and goals, we can choose the best treatment plan for you.

What Is Nonsurgical Therapy for an ACL Injury?

Immediately after an ACL injury, it's important to rest and reduce swelling, which can damage other parts of the knee joint. Reducing swelling is key, whether you need nonsurgical or surgical treatment.

Once swelling goes down, you can start exercises to strengthen the muscles that support the knee.

Reducing swelling

To reduce swelling in the first few days after an ACL injury, your doctor may recommend:

• Applying ice for 10 to 20 minutes at a time, several times a day.
• Compressing the knee by wrapping it tightly with a bandage. Your health provider will teach you the proper way to wrap your knee.
• Elevating your knee above your heart by lying down and resting your leg on pillows.
• Taking anti-inflammatory medications like ibuprofen.

Activity restrictions after an ACL injury

Your doctor will advise you on how long to rest each day, and what knee movements to avoid. Crutches can help relieve pressure on the knee and support healing during the initial recovery period.

You'll need to avoid sports, like jogging and swimming, for many months. You'll also need to refrain from other activities that stress the knee, like lifting heavy objects. A repeated MRI or other imaging test can reveal whether your ACL has healed enough for you to resume certain activities.

Physical therapy

Most people can start physical therapy as soon as their swelling and pain improve.

Your physical therapist will help you slowly work up to doing 30 or more repetitions of each of the exercises they suggest.

Some of the exercises ACL rehabilitation includes are:

• Calf raises — Standing upright and holding on to a chair, slowly raise your heels so you are standing on the balls of your feet. Hold this for a few seconds, and then lower your heels back down.
• Band exercises — Your physical therapist can teach you how to use exercise bands to strengthen the muscles on the inner and outer sides of your legs.
• Knee bends — Sitting on the floor with your legs straight out in front of you, you put your hands behind the thigh of your injured leg. Then, you pull the knee to your chest with your back straight, before slowly lowering your leg.
• Quad exercises — When sitting with your leg straight, flex your quadriceps muscles (the muscles at the front of your thigh) and hold for 10 seconds.
• Straight leg raises — Lie down with your uninjured knee bent, with your foot on the floor, and your injured leg straight. Flex your quad muscles and lift your straight leg a foot or so off the floor and then slowly lower it.

Immobilization

Your doctor may recommend a brace that keeps your knee in a bent position for several weeks. After this, you can gradually increase movement with the help of a physical therapist.

Braces

Some people prefer to wear flexible knee braces after an ACL injury. Although they may provide extra support, research hasn't shown that they improve ACL injury healing or prevent a future ACL injury.

Who Is a Candidate for Nonsurgical ACL Therapy?

Those who may benefit from nonsurgical treatment for an ACL injury include:

• People who are older than 50. Older people have a higher risk of complications with ACL surgery. Surgery can still be the best option for older people, especially if they don't have other health problems.
• People who don't play sports, especially sports that require pivoting or twisting the knee.
• People who have a more minor ACL injury, like an ACL that's overstretched rather than torn.
• People who have health problems, like diabetes or bleeding disorders, that increase their risk of surgical complications.
• People who smoke. People who smoke don't heal as well post-surgery as people who don't smoke.

What Are the Risks of Not Getting Surgery for an ACL Injury?

Nonsurgical treatment means you avoid the potential complications of surgery, like infection, bleeding, and nerve damage. But not having surgery also has risks, including:

• A worsened injury. A partially torn ACL can tear completely, which is why it's important to carefully follow activity restrictions and physical therapy guidelines.
• Knee instability, where the kneecap frequently moves out of place.
• Inflammation that damages other parts of the knee, like the cartilage or the meniscus.
• Arthritis, or pain and stiffness in the knee joint, due to long-term inflammation.

Your doctor can explain the benefits and risks of a nonsurgical approach versus surgery as it pertains to your unique situation.

Your doctor may advise you to try a nonsurgical approach first and monitor your progress. Through follow-up appointments, your doctor will assess your symptoms and repeat imaging tests, as needed. If nonsurgical treatments aren't working, your doctor may suggest surgery.

What Should I Expect from Nonsurgical Therapy for an ACL Injury?

ACL injuries can take anywhere from weeks to months to heal. The timeline will depend on the severity of your injury, your age, and your general health. It will also depend on how well you stick to your activity restriction guidelines and physical therapy exercises.

You should let your doctor know right away if you notice pain, swelling, or "popping" of the knee. These may be signs that your ACL isn't healing well.