Dr. Henry Chan of HC Orthopedic Surgery discusses a non-surgical approach to ACL tears and whether it’s the right option for you
What is the ACL?
The anterior cruciate ligament (ACL) is one of the key stabilizing ligaments in your knee. It’s a pinky-sized band of tissue inside the joint that connects the thighbone to the shinbone. When you’re doing activities that involve quick changes in direction— think soccer, table tennis, basketball, skiing—you can thank your ACL for your steady knee.
Why is it important?
Without this ligament, the knee tends to give way. When you turn, the shinbone doesn’t follow the thighbone and your knee buckles. With each occurrence, you risk greater damage to the knee tissue and increasingly early onset of post-traumatic arthritis (arthritis that develops as a result of injury).
Is anything else damaged inside my knee?
Yes. The twisting that causes an ACL injury often damages other parts of the knee as well, such as cartilage or the meniscus (the fibrous tissue inside your knee that serves as a bumper between the bones).
What would happen if I did nothing about this injury?
You’ll find yourself prone to repeated injury; and ultimately, you’ll accelerate the development of post-traumatic arthritis. Think of your knee as a car. If you don’t fix a problem, eventually it breaks down.
What does conservative treatment mean?
The good news is that not every patient with an ACL injury requires surgery. Conservative, non-surgical interventions aim to rehabilitate the ACL through a combination of strengthening, lifestyle modifications, and bracing.
How does a brace help?
A knee brace does the work of your ligament from the outside. It stabilizes the joint during rotational motion. However, your ligament will never heal by itself, and there’s a limit to how much a brace can compensate.
What about strengthening and stretching?
The hamstrings, the muscles that run along the back of the knee, and the ACL work together. When the ACL tears, stretching and strengthening develops the hamstrings so that they can do some of the ACL’s previous job.
Is a conservative approach right for me?
The plain truth is that if you’re very active and keen to remain so, you may want to pursue surgery or risk repeated knee injury. But if you enjoy a more modified lifestyle, consider conservative treatment. With conservative treatment, you can safely expect to regain 50-to-60 percent of your previous functionality. Back to the car analogy, think of your knee has having a 60km speed governor. Will that work for you?
How do you determine whether a patient needs surgery or can pursue non-surgical options?
We make those decisions based on age and lifestyle. Patients under age 40 are generally considered suitable. This is because as you age, you likely have some degree of concomitant arthritis, which a ligament injury will further damage. It may not be enough to repair the ACL. You might require a knee replacement.
Dr. Henry Chan is the Medical Director at HC Chan Orthopedics, a joint pain specialist at Mount Elizabeth Medical Centre (Orchard). He trained in Singapore and Germany for primary and complex joint replacement surgeries. Dr. Chan is also Adjunct Assistant Professor in the Department of Orthopedic Surgery in Yong Loo Lin School of Medicine, National University of Singapore. To date, he has performed more than 1000 joint replacements.
To learn more about Dr. Chan’s practice, click here.