Study suggests wait before ACL surgery

NEW YORK – Attention, weekend athletes: Don’t be too quick to agree to surgery for a common type of knee ligament tear.

A study of Swedish amateur athletes – mostly soccer players – found that those who got an ACL reconstruction right away, plus physical therapy, fared no better than athletes who started out with rehab and got the surgery later if they still needed it.

Of those in the rehab-first program, fewer than half went on to get the surgery within two years, researchers reported in today’s issue of the New England Journal of Medicine.

“It seems that if you start out with rehabilitation only … you have a good chance of ending up with an equally good outcome as if you had early ACL surgery,” said Richard Frobell of Lund University Hospital in Sweden, an author of the work.

“Maybe we will be surprised that a lot of people actually do not need an ACL reconstruction.”

Frobell stressed that the study did not include professional athletes. They usually seek surgery to get back into action quickly rather than waiting to see if rehabilitation works.

About 200,000 Americans each year have surgery to replace the anterior cruciate ligament, or ACL, which is crucial for knee stability. It can get torn in sports, like football and soccer, that require planting the foot and pivoting.

Doctors already knew that not every patient with a torn ACL needs surgery; a middle-age jogger or cyclist can often get by with a knee brace and rehabilitation, experts say. Frobell said his work suggests that the same strategy might work for athletes who want to return to more strenuous sports like soccer, at least on lower competitive levels.