Can an ACL Tear Heal Without Surgery?

For many people with an anterior cruciate ligament (ACL) injury, the questions begin immediately. Will I need to have ACL surgery to walk again? Is surgery required before I can get back to exercise or to playing sports? Not necessarily! Multiple factors determine whether an ACL tear requires ACL repair or reconstruction, including injury severity, knee joint stability, activity goals, and whether other knee structures have been injured.

Resource: aclstudygroup.org

Estimated reading time: 7 minutes

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Understanding the ACL and What Happens When It Is Injured

Some people with an ACL tear can return to their baseline level of activity, including running and jumping, without surgery after an appropriate course of physical therapy and time with a rehabilitation specialist. Certain partial ACL tears may heal, and some individuals with a complete tear can return to an active, fulfilling lifestyle after non-surgical care. Surgery may still be recommended depending on activity level, if the joint feels unstable, if other knee structures were torn, or if the patient returns to a sport or activity that involves frequent cutting, pivoting, jumping, or abrupt stops.

Can Some ACL Tears Heal Without Surgery?

Some people with an ACL tear can return to their baseline level of activity, including running and jumping, without surgery after an appropriate course of physical therapy and time with a rehabilitation specialist. Certain partial ACL tears may heal, and some individuals with a complete tear can return to an active, fulfilling lifestyle after nonsurgical care. Surgery may still be recommended depending on activity level, if the joint feels unstable, if other knee structures were torn, or if the patient returns to a sport or activity that involves frequent cutting, turning, jumping, or abrupt stops.

Resource: medlineplus.gov

Does an ACL Tear Have a Chance of Healing on Its Own?

The ACL has much lower rates of healing than other ligaments in the knee. This is due to the environment in which the ligament sits, including its location within the joint, decreased blood supply, and potential irritation from contact with joint fluid. It may be difficult for the injury to heal on its own. Studies suggest that some injured ACLs do show evidence of healing on an MRI scan after nonsurgical treatment. It is possible to see signs of healing on an MRI that do not correspond to a return in the function or strength of the ligament. Not all ACL injuries will heal. Treatment goals should remain central when assessing functional performance and knee stability during daily activities, exercise, and competitive sports.

Resource: my.clevelandclinic.org

The knee may regain stability even when the torn ACL does not heal completely or undergo surgical reconstruction. Patients may regain function through:

• Stronger leg muscles
• Better balance
• Improved coordination
• Proper movement mechanics
• Changes to daily activities

These improvements may help the knee function even when the ACL remains injured.

What Type of Patient Can Expect Success With Nonsurgical ACL Treatment?

Nonsurgical treatment may be appropriate if:

• The patient had a partial tear without signs of instability
• The patient had an isolated ACL tear with minimal or no instability
• The patient’s activity goals do not include many cutting or turning movements
• The patient is willing to complete all elements of ACL rehabilitation
• The patient can meet rehabilitation and physical activity goals

Age is often considered a factor in the decision to operate or not, though the ability of the patient to move the knee effectively and without giving way during daily life and sport can be more important. Patients should be aware that repeated instability or giving out can place the meniscus and cartilage inside the knee at risk for further damage, so the injury should be assessed by a sports medicine specialist to rule out the possibility of a partial or complete meniscus tear and for evaluation of the stability of the knee joint as a whole, prior to the completion of rehabilitation.

When Might ACL Surgery Be Recommended?

If symptoms persist and do not improve following nonsurgical treatment, surgery may be indicated if a patient:

• Has recurrent instability, pain, or a frequent “giving out” of the injured knee
• Has a desire to return to a sport with significant cutting, rotating, or jumping
• Has an associated meniscus tear, cartilage loss, or injury to another ligament
• Has a locked knee, has a significant loss of range of motion, or does not appear to be improving with physical therapy

An orthopedic surgeon and physical therapist can look at the injury, your strength, the quality of your motion, your goals, and your sport needs before making treatment recommendations.

How Physical Therapy Fits Into ACL Recovery

Physical therapy is an important part of ACL recovery, whether or not treatment involves surgery. Early rehab often starts with reducing swelling, restoring knee motion, and walking in a normal way. Later stages might include:

• Strengthening your quadriceps, hamstrings, hips, and core
• Balance and joint-position work
• Training safe landing and stopping techniques
• Running, agility training, and sports-specific practice
• Functional testing before playing sports

Your physical therapist will watch for swelling, pain, motion, weakness, and instability episodes. Adjustments in exercise are made based on how you are doing rather than the number of weeks from when you were injured.

How Long is ACL Recovery Without Surgery?

Recovery time is different for every person based on the severity of the injury, swelling, stiffness, strength of muscles, stability of the joint, and the kinds of activity someone wants to do again. Nonsurgical ACL rehabilitation can last months, particularly when the goal is to return to running, jumping, or team sports. Progress is made based on functional goals. Being able to do everything again, not just having full motion, low swelling, strong leg muscles, and balance, and passing functional testing before returning to sports, all contribute to deciding if your knee is ready to go back to a higher level of activity. Some people start off with nonsurgical rehabilitation and then decide on surgery because they can’t keep their knee stable or because their goals have changed. Rehabilitation before ACL surgery might help recovery after the operation.

When to See Your Doctor for an ACL Tear

You should be evaluated for a knee injury that resulted in a pop, swelling within a few hours, problems with weight bearing, or the knee giving out more than once. You should get urgent medical care if your knee looks deformed, your foot feels cold or numb, if your pain is severe, or your knee is locked. A physical therapist can observe motion, strength, swelling, your gait, and your ability to do everyday things. Your physical therapist might recommend imaging or an orthopedic surgeon’s consultation if your evaluation is concerning for a significant injury.

Common ACL Injury Questions

Can You Walk With a Torn ACL?

Many people are able to walk after tearing their ACL when the pain and swelling start to go away. However, just being able to walk doesn’t mean that your knee has enough stability to run, cut, pivot, or compete in sports.

Will a Partial Tear of the ACL Heal Without Surgery?

It might. A partial ACL tear may heal or become functionally stable with rehabilitation when the remaining ACL fibers are intact, and your knee isn’t giving out.

Can a Complete Rupture of the ACL Be Treated Without Surgery?

A complete ACL rupture may be treated without surgery when your knee remains stable during desired activities. Your ability to be managed without surgery may depend on your physical therapy and changing activities. If your knee is giving out, surgery may be a better option.

Does Physical Therapy Make ACL Surgery Unnecessary?

Physical therapy may help determine if nonsurgical care is a reasonable choice and improve knee stability enough to do things every day, as well as participate in some sports. Preoperative rehabilitation will help prepare your knee if you eventually want to have surgery.

What Happens if an ACL Tear Is Not Treated?

Knee instability might lead to meniscal or cartilage injury over time. People without functional instability may be able to return to daily tasks and sports after rehabilitation. Choosing to ignore your ACL injury is different from electing a nonsurgical rehabilitation plan and having a close watch on your symptoms.

Final Thoughts

An ACL rupture doesn’t necessarily mean you will have surgery. Get a personalized evaluation for your knee injury. Peake Physical Therapy provides ACL rehabilitation for people pursuing nonsurgical care, preparing for surgery, or recovering after reconstruction. Schedule an appointment to have your knee assessed and discuss the next step in your recovery.