The Anterior Cruciate Ligament or ACL, are the dreaded three letters no athlete wants to hear after suffering a knee injury. When people think of ACL injuries they often associate them with surgery followed by an extensive period of time on the sidelines. What if surgery isn’t the only way to manage an ACL rupture? In recent years we have started to see more research into whether conservative management is a plausible option, with some health professionals arguing it may even be more beneficial than surgical treatment. There are a lot of factors that need to be taken into consideration when comparing the two, so let's take a deep dive into the latest research.
What is a coper? The term “coper” is one that is starting to pop up more frequently when discussing conservative management of ACL injuries and this grouping of patients are expected to have more favourable outcomes than non-copers. This is still a fairly new concept and will continue to be researched in the coming years. To put it briefly, copers have fairly good knee stability and are able to better compensate following an ACL rupture, whereas non-copers have poor knee stability. Hurd et al. in 2009 has outlined a criteria which at the moment is considered the best definition of a coper, using a mix of functional testing and questionnaires:
More recently this criteria was successfully implemented but Wellsnadt et al. in 2018 in a much larger sample size across two continents. Although more research is required to determine whether patients using this criteria manage better than others, it does give us an indication that knee stability is an important factor to take into consideration as to whether someone is more likely to respond positively to conservative management.
So which treatment option should you choose? Conservative management of ACL injuries is still fairly new and as mentioned earlier, current evidence displays no significant difference in comparison to surgical intervention. Despite this conservative management now opens up another treatment option creating a shift towards a more patient-centred approach. Discussing your goals with your Physiotherapist is key and they will be able to assist you in making an informative decision as to which treatment option is best suited for yourself and understanding the path you are taking. Zadro and Pappas in 2018 found that patients are often misguided into thinking surgery will “fix” their knee and is superior to conservative management. It is important to note that if there are other structures injured such as the MCL or meniscus, surgery may be indicated regardless to repair all structures. Most importantly regardless of which path you take, do not underestimate the importance of Physiotherapy. Although you may find yourself returning to work and other low impact activities sooner if conservatively managing your ACL injury, it will still take 6-12 months or longer to achieve full recovery and return to sport. It is a long road to recovery and working closely with your Physiotherapist will help you achieve a faster recovery and reach your goals. Watch this space! Current research still favours surgical intervention as the best pathway for those suffering a ruptured ACL particularly for a younger, more active person. Recently we have started to see more research which suggests conservative management, however in the next few years we may have a better idea as to how viable it is in the long term. It is an exciting time and we will continue to keep an eye out on the new research that will come out regarding these management strategies in the coming years.
Give us a call on (02) 9620 4948 and we can book you in with one of our Physiotherapists and assist you with any questions you may have. If you are looking for more information regarding the management of ACL ruptures, check out these references below:
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