ACL Injuries: Surgery vs. Non-Operative Rehab — What Does the Research Really Say?
ACL injuries occur at a rate of 100,000 to 200,000 cases per year in the United States. Historically, athletes have feared this injury because many believed it meant they would never return to their prior level of sport. Fortunately, advances in surgical techniques, rehabilitation, and clinical understanding have significantly improved outcomes. Today, most athletes are able to return to— or close to—their pre-injury level of performance.
For decades, the traditional orthopedic recommendation has been clear:
If you want to return to sports, you should have ACL surgery.
The reasoning is that without the ACL, other knee structures may experience increased stress during high-demand activities, potentially increasing the risk of additional injury or future osteoarthritis.
But recent evidence suggests the decision may not be as straightforward as once believed.
What the New Research Shows
A recent study titled “Does Anterior Cruciate Ligament Reconstruction Improve Functional and Radiographic Outcomes Over Nonoperative Management 5 Years After Injury?”, published in the American Journal of Sports Medicine, examined 144 athletes over a 5-year period.
The findings revealed no clinically significant differences between the surgery and non-surgery groups in:
Pain scores
Performance-based testing
Presence of arthritis
Activities of daily living
Knee-related function
This does not mean surgery is unnecessary for everyone—but it does challenge long-held assumptions about what is “best practice.”
Important Considerations
All research should be interpreted carefully and not generalized to every individual. This study does not claim that surgery is never beneficial or that non-operative management is universally superior. Rather, it suggests something important:
Even surgeries historically considered “essential” may not always be the right choice.
Every ACL injury is unique. Factors such as activity level, knee stability, sport demands, age, goals, and associated injuries should all be considered before making a decision.
If you’re facing an ACL injury, speak with a qualified physical therapist or orthopedic specialist who can help you weigh the risks, benefits, and evidence for your specific situation.
Our Perspective at Kauno
At Kauno, we pride ourselves on being research-driven. We believe our community deserves information that is grounded in quality data—not fear, outdated beliefs, or subjective opinions.
Whether you choose surgery or non-operative rehab, we believe in empowering you with evidence, education, and a plan that aligns with your goals.
Reference
Wellsandt, E., Failla, M. J., Axe, M. J., & Snyder-Mackler, L. (2018). Does Anterior Cruciate Ligament Reconstruction Improve Functional and Radiographic Outcomes Over Nonoperative Management 5 Years After Injury? The American Journal of Sports Medicine, 46(9), 2103–2112. https://doi.org/10.1177/0363546518782698
