Surgical Vs Conservative: Which Treatment Is Better for ACL Injuries in Elite Athletes?

As we all know, the Winter Olympics concluded in a magnificent manor at the weekend, and one of the main trends we saw in athletes this year was… anterior cruciate ligament injuries! This isn’t really something we want to celebrate, but ACL injuries are always prevalent in athletes, particularly young females and in sports such as Alpine skiing, because of the impact an athlete's knee is experiencing on landing.

Having a well-designed and carefully considered prevention programmes for said athletes im vital, as it will reduce the risk of an ACL injury occurring or later developing into a serious injury. These programmes are put in place to change the dynamic loading of the tibiofemoral joint neuromuscular and proprioceptive training. But when creating and designing such programmes, we need to consider what kind of management is best; surgical reconstruction or conservative management?

There is quantifying evidence showing us that non-elite patients that have experienced an ACL injury will develop similar knee injuries up to 5yrs post-op compared to those who choose to have surgical reconstruction.

With this in mind, we need to consider this all important question; if the end results for surgical management and conservative management in non-elites tend to be similar, why do most elite athletes decide to have some form of ACL reconstruction?

Avoiding surgery is always an ideal choice for many athletes as they can return to their beloved game much quicker than the current recommendation of nine months after ACL reconstruction - and reducing time-loss after any injury is always a good thing!

We all know that the demands - both physically and psychologically - of an elite sports athlete is much higher than those of us that partake in a friendly game of football once or twice a week. However, not all elite athletes may need to undergo ACL reconstruction, and to prove this to you we will provide you with a case study of a professional football player.

He was 32 years old, and was a premier league football player who decided to choose conservative treatment and managed to return to play at an impressive eight weeks after ACL injury; and was still consistently playing for his club after 18 months.

This case was considered an incredibly bold move by the player himself, the medical staff and the club too, as it goes against the norm of conventional practices. There could have been other factors involved when he decided to down the route of conservative management - maybe the player had nothing to lose? And maybe a long time period away from the sport would limit his contract extension negotiations? Who knows what their motivations were, but whatever they were, their gamble paid off!

There are probably plenty more questions that you have have about conservative management, but don’t fret, we know it’s simply not possible for all elite athletes to be conservatively managed. But what this case should demonstrate to you, is that there are other options elite athletes can take when treating an ACL injury, and they will still be able to return to their sport as good as new within a short space of time!

However, we wonder which player, medical staff or club will be brave enough to choose to use conservative ACL management and build up stronger pro case for this type of treatment?


Image Source: CBS Boston - CBS Local