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Do you need knee ACL surgery for a partial tear?

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The knee ACL is one of the main ligaments in the knee that helps to stabilize it in a front back direction.  When this ligament gets injured, many patients opt to have it replaced.  The logic goes that without a strong ligament, especially when they’re active, the knee may be prone to more damage.  In addition, the wisdom has been that even a partial tear was unlikely to heal.  However a new research study out this week questions that concept.  In this study, athletes with knee ACL tears were randomly assigned to either surgery to replace the ligament or follow a strict physical therapy program.  60% of the athletes that didn’t get the knee surgery never needed to have the ACL replaced.  This brings up an important point.  We have seen more patients getting ACL surgery to replace the ligament, even with partial tears.  We would advocate that these patients wait to see if the ligament heals and if it doesn’t heal, many non-surgical options exist that we believe should be tried before surgical replacement of the ACL.  These include prolotherapy (study by Reeves showing effitiveness) or PRP injections (platelet rich plasma taken from a vein, spun down, and injected into the knee).  We believe these injections should be guided by imaging (x-ray or ultrasound).  We have also helped select patients with full thickness (non-retracted) or partial ACL tears by injecting their own stem cells into the tears.  If all of the less invasive injection options fail, then replacing the ligament may be needed.  However, Frobell’s study shows that for many athletes with ACL tears, just letting it heal over time may be enough.

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