Sharp knee pain and instability from sports?

Have you recently injured your ACL? 

The management of ACL injuries is a hotly debated topic in sports medicine. For so long we have thought that when ACLs rupture that they cannot heal on their own and require surgical intervention. But we know now that it is not the case and in fact, more recently, our evidence does not support surgery over conservative management. The best quality evidence now suggests that you have options! 

The recommendation from our latest evidence tells us that most people could trial a period of rehabilitation and may not even require surgery.

Obviously, if after a period of rehabilitation, you are still experiencing feelings of instability or limited function you can revisit the need for surgery and there is no additional risk or consequences for delaying this. In fact, you may have better postoperative outcomes than those who underwent early surgery!

In another more recent study (2023) using a cross bracing protocol, 90% of patients had full recovery healing of their ACL! This protocol involves bracing the knee in various positions for a total of 12 weeks. 

Of course there are various factors which may indicate the need for either conservative management or surgery for your ACL injury. This includes things like your scan findings, your range of motion, muscle strength, what you need to get back to (high level sport vs leisurely sport) and of course personal preferences. 

Speak with one of our physiotherapists and book in for an appointment to find out more about your options when it comes to managing your ACL injury. Also check out below my favourite tips when it comes to a knee injury! 

My favourite tips for managing a knee injury:

1. See a physio! Stop ignoring that knee “niggle” and continue to let it impact your movement and daily activities. Getting on top of it quickly can make all the difference in the long term. 
2. Get a diagnosis. Make sure you get an accurate diagnosis from a physiotherapist. Your physiotherapist will take a look at your range of motion, strength, problem activities and imaging to provide you with a diagnosis and treatment pathway. 
3. Avoid activities that will make your knee pain worse during the first few days of the injury.
4. Elevate the injured leg higher than the heart to help minimise swelling.
5. Icing or an ice massage for 20 minutes on and off can help with pain.
6. Compression bandages can help with swelling and should be worn 24/7 during the initial stages of injury.
7. Soft tissue massage from a physio can help move excess fluid, pain and swelling away from the injury site. 
8. Pick a cardiovascular exercise that is pain-free to help increase blood flow to the injured site. This could be cycling on a stationary bike, gentle walking, rowing machine or elliptical. 
9.  Finally, choose a physio that will provide you with a strength, mobility and balance rehabilitation program to get you back on track! 

References:

1. Filbay SR, Dowsett M, Chaker Jomaa M, et al. Healing of acute anterior cruciate ligament rupture on MRI and outcomes following non-surgical management with the Cross Bracing Protocol. British Journal of Sports Medicine. Published Online First: 14 June 2023. doi: 10.1136/bjsports-2023-106931
2. Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med. 2010 Jul 22;363(4):331-42. doi: 10.1056/NEJMoa0907797. Erratum in: N Engl J Med. 2010 Aug 26;363(9):893. PMID: 20660401.