ACL rupture – Why I decided to go conservative?
My conservative ACL management journey
After I completely tore my ACL playing field hockey in November 2018, I was almost immediately booking my
surgery to get it over with as soon as possible. After an interesting conversation with a colleague in
Australia, we started discussing ACL conservative management. This sparked interest as it is becoming
more popular due to the rate of ACL tears increasing annually. Most of the research studies I read were
based on ACL tears alone, they did not include meniscus or MCL tears (of which I had both). After
gathering all the information I needed with regards to the two approaches, I decided to try the
conservative treatment first. Many people were concerned seeing as I play a pivotal sport and the lack
of an ACL might lead to further damage of my knee. I knew that this was what I needed to do though, so
off I went.
I spent 5 weeks non-weight bearing (crutches) and restricting my knee flexion (bending) to 90 degrees.
This was essential to allow for optimal posterior horn medial meniscus healing. During this time I started
strengthening my Vastus Medialis Oblique (VMO is essential for full knee extension and knee stability),
glute medius (important for hip stability), glute maximus (needed for hip extension when you are
walking and seeing as I wasn’t, I needed to maintain the strength I had), calf muscles, hamstrings and
abdominals. The E-Stims machine (Compex) came in very handy when trying to strengthen muscles
without weight bearing. I would highly recommend it as the improvements are immense.
I spent hours on Range Of Motion (ROM) and decreasing swelling through Rest Ice Compress Elevate
(good ol’ RICE). When it came time to start weight bearing, the research directed me towards my first
goal. Before you consider conservative you first need to be identified as a COPER. Seeing as my initial
focus was on my meniscus it was time for me to ramp it up.
According to the research “Rehabilitation candidates are those patients who meet all 4 criteria:
(1) Timed hop test score of 80% or more of the uninjured limb
(2) Activities of Daily Living (ADL) score of 80% or more
(3) Global rating of 60% or more, and
(4) No more than 1 episode of giving way since the incident injury to the time of screening
Patients who fail to meet any of these criteria are classified as noncandidates.” I’ll discuss the following
tests in detail in my next blog. Steps 2-4 were easily passed, but the timed hop test required many hours
in the gym to feel comfortable to perform several tests hopping on one leg. I managed to complete
these tests successfully 3 months after the initial injury. This boosted my confidence and allowed me to
continue with the ACL protocol I had put in place.
Unfortunately there is no conservative ACL protocol, so I constructed my rehab by following an ACL
reconstruction protocol (which is readily available and doesn’t differ considerably between orthopedic
doctors) and I added in extra strength work for my hamstrings and calf muscles because I needed to
improve my tibial translation. Tibial translation is when the tibia (bone of the lower leg) moves
anteriorly in comparison to the femur (bone in your thigh) due to the deficiency of my ACL. Now you can
imagine that would cause long term problem if the alignment of the knee was disrupted. I will also
discuss the operative rehab process in a separate blog.