Physical Therapy vs Surgery for ACL Injuries


Damage to the anterior cruciate ligament (ACL) is a common sports injury that can be debilitating and in some cases career-ending for athletes.

The ACL is a major knee ligament that connects the femur to the tibia. Risk for ACL injury is higher for some sports than for others. ACL ruptures are most common in high-risk sports like football, basketball, hockey and soccer.

It is increasingly common for doctors to steer injured athletes with ACL ruptures toward quick surgery, hoping to prevent long-term consequences such as osteoarthritis and menisci tears. However, there is mounting evidence that conservative management of ACL injuries, including physical therapy, are just as effective in resolving the injury. Furthermore, conservative treatment for ACL tears is reversible, while ACL reconstructive surgery is permanent.

The Research

There are a plethora of experimental studies and reviews that address the topic of surgery vs physical therapy after ACL injury. Two of the most compelling come from Frobell et al. (2010 and 2013).

  • In the first study, researchers performed a randomized controlled trial to compare early ACL reconstruction to early rehabilitation with optional delayed ACL reconstruction. Participants were 121 injured athletes with a mean age of 26. The athletes were evaluated at three, six, 12 and 24 months, using outcome measures of pain, function, osteoarthritis measures and other tests. Both groups improved in all measures over the course of two years. There was no significant difference between the two groups. In 61% of the rehab group, surgical reconstruction was avoided without compromising results. The research team concluded that early ACL reconstruction did not lead to better outcomes than rehabilitation with optional delayed ACL reconstruction.
  • The follow-up study by the same authors revisited the athletes after five years and found no difference between the two groups. However, athletes who received a patellar graft for ACL reconstruction had a higher incidence of patellofemoral osteoarthritis. Five years after treatment, 50% of the early rehabilitation and optional reconstruction group did not need ACL reconstruction

Regardless of whether ACL patients elect to have surgery, or to pursue conservative treatment, physical therapy plays a key role in restoring knee function, increasing an athlete’s chances of returning to play after ACL rupture.

ACL Rehab in NYC

If you have suffered an ACL injury, NYDNRehab in NYC offers some the most technologically advanced diagnosis and treatment strategies in the USA. Before agreeing to ACL reconstructive surgery, visit the sports medicine professionals at NYDNRehab to explore your options. Our team of sports injury experts will give you an accurate diagnosis, and devise a rehabilitation program based on your specific individual needs. If your intent is to return to play with full knee function, contact NYDNRehab today, and see why we are the very best rehabilitation specialists in NYC.


Frobell, RB et al. A randomized controlled trial for acute ACL tears. N Eng J Med. 2010;363(4): 331-342.

Frobell, RB et al. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013; 346:1-12.


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