ACL tears are one of the most common injuries in sports with between 100 to 200 thousand occurring in the United States annually. Female athletes are at a significantly higher risk than males in the same sport. This is most evident in soccer and basketball where females are 6-9 times more likely to tear their ACL. Previously it was thought that every ACL tear required a surgical intervention, but multiple randomized, controlled trials have shown equivalent outcomes between conservative care including Physical Therapy and surgical interventions followed by surgery. Due to these studies authors have continued to ask questions regarding timing of surgery for these injuries. Do they require immediate surgery or similar to other orthopedic injuries can surgery be delayed until a trial of Physical Therapy is complete?

A recent systematic review and meta analysis of the available evidence was performed to determine the outcomes associated with early surgical interventions vs. early Physical Therapy interventions for patients with an ACL tear (Saueressig et al. Br J Sports Med. 2022). Authors reported on 3 prior trials of 320 participants. Authors reported no significant differences in development of knee arthritis at short or long term follow up whether participants underwent surgery for their ACL tears. In addition, no significant differences were noted between Physical Therapy and surgery for any secondary outcomes.

This study highlights the current uncertainty on which of these two treatment pathways produces the best clinical and functional outcomes for our athletes. Currently, athletes are encouraged to begin Physical Therapy after ACL injury with an optional surgery if important clinical and functional outcomes are not achieved.

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