Weigh up the pros and cons of treatment options
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To make a treatment choice that is right for you, it's important to look at your treatment options and compare the pros and cons of each of each of these. Under each of the headings below, explore the pros and cons of each treatment option.
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Treatment cost:
ACL surgery costs more than rehab without surgery. This cost will vary depending on your health insurance. Lower cost ACL surgery is offered in the public system in Australia but usually has long waiting list times of between twelve to eighteen months.
Risk of surgical complications:
ACL surgery comes with a risk of serious and less serious surgical complications. The surgeon’s choice of techniques and devices can affect the outcomes and risks.
Serious complications (0.7%)
E.g. myocardial infarction (<.01%), stroke (<.01%), pulmonary embolism (0.1%), infection requiring surgery (0.5%), fasciotomy (.02%), neurovascular injury (.02%), death (.01%)
Bleeding complications, post surgery blood loss, blood transfusion, injury to an artery
Deep vein thrombosis: 9.7%, pulmonary embolism: 0.1%, pseudaneurysms: 0.3%
Tibial cyst (3.9%), abscess, cyclops lesion (swelling, pain, tenderness, instability)
Knee joint contracture: restricted movement (2-43%), stiffness (3%) and pain
Infection, allergic and foreign body reactions, poor wound healing: infection rate varies (2-11%) depending on type of screws/staples
Implant breakage, migration and failure
Graft site complications:
patellar fracture (0.4-1.3%), hamstring retraction, reduced strength/size, anterior knee pain (15-81%), kneeling pain (10-57%)
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Nerve damage (sensory loss): 40-80% of hamstring grafts
Bone tunnel widening, fracture of bone due to bone drilling, tunnel malpositioning, thermal necrosis
Septic arthritis (0.4-2.1%), chronic inflammation of joint structures, cellulitis
Pain medication and general anaesthetic complications: e.g. nausea, vomiting, sedation, postdural puncture, headache, sweating, dizziness
Graft failure or rupture, surgical revision
Avoiding knee surgery
You will have knee surgery under a general anaesthetic and may stay the night in hospital.
Knee stability
A successful outcome from ACL reconstruction surgery will mean that your knee feels stable and you regain full movement once recovered from surgery.
An unsuccessful outcome can include an unstable knee or restricted knee movement.
Length of recovery
The length of rehab is typically twelve to eighteen months after ACL surgery.
Some people may take longer to recover or may not fully recover if they are not happy with the results of the surgery.
Convenience
ACL surgery will result in some time of pain, swelling, poor function and being restricted in what the knee can do. After the surgery, you will need to walk with crutches and will not be able to drive for up to six weeks.
Some people with private health insurance may choose to delay the surgery and book in for surgery at a particular time of year when it is most convenient.
Potential for natural healing of the ACL
The torn ACL is removed during ACL reconstruction surgery, meaning that there’s no chance of the ACL healing in the future.
Muscle strength and function
In a successful surgical outcome, you should regain at least 90% of your thigh muscle strength.
On the other hand, muscle weakness and reduced muscle control can persist beyond twelve months of ACL reconstruction surgery. You may also have pain or weakness where the graft is taken from.
Further knee injury
If you have ACL reconstruction surgery there is a risk of rupturing the ACL graft, which can lead to poor long-term outcomes. Further injuries to other parts of the knee can also occur.
Return to sport
Return to sport is not typically advised until twelve months after ACL reconstruction surgery. 55% of people return to competitive sport after ACL surgery.
Fear of re-injury is the most common reason people don’t return to sport after ACL reconstruction surgery. Your risk of re-injury may be higher if you return to sport while you have reduced knee strength and function.
Satisfaction with knee function
About half of people are satisfied with their knee function two years after ACL surgery, or two years after rehab without surgery.
Knee osteoarthritis (OA)
More knee swelling and cartilage changes occur after ACL reconstruction surgery. ACL surgery may lead to higher rates of knee OA, as seen on x-ray. But it’s important to know, that having a knee x-ray that shows OA doesn’t mean that you’ll have any knee pain and symptoms. Few studies have compared rates of painful OA between treatment groups.