May 24th, 2013

Health N

Staff Report

Health N
Kentucky's Nerlens Noel tore his ACL in February / photo from the Washington Post

Louisville Orthopaedic Clinic shares insight on surgery

Do all ACL tears need surgery?

By: Ty E. Richardson, M.D.                         

As a part of the Louisville Orthopaedic Clinic, the Sports Rehab Team physical therapists are knowledgeable and trained in the latest advancements and techniques available in sports rehabilitation.

On a weekly basis, the Health N’ Sports Update will give information on prevention, recovery, and include special offers, as well as general health tips that would be beneficial to all. If there is a specific topic you’d like to know or hear more about, email future suggestions to

The anterior cruciate ligament or “ACL” is the primary stabilizing ligament of the knee. Around 200,000 people suffer an injury to this structure annually. For the last couple of decades, the trend in treatment has leaned more toward early surgical reconstruction and accelerated rehab. Improvements in technique and equipment have made ACL reconstruction a very successful treatment for those who choose surgery. But, does every ACL tear require reconstruction? If you’re Carson Palmer, the quarterback for the Cincinnati Bengals, and surgery may mean the difference between early retirement or returning to play and your 15.7 million dollar salary, the choice is obvious. But what about the thirty-year-old office worker who runs a couple of days a week and plays a little golf on the weekends and tore his ACL at a church softball game? The issues and options are a little different. Can this patient be treated without surgery and have a good long-term outcome? 

There is a subset of ACL patients who can be treated without surgery, they are called “copers” and do very well with a supervised rehab program and slow return to activity. These people tend to have excellent neuromuscular control, quadriceps strength and ankle stability. They are able to continue to remain active in all but the most demanding sports such as football and indoor soccer. Bracing is another nonsurgical option. A brace can improve a patient’s subjective sense of stability and are only worn during sporting activity. John Elway won a Superbowl with a brace on his ACL deficient knee. However, bracing does not protect the knee from the long-term effects of instability. 

But what are the short and long-term effects of leaving a torn ACL untreated? There are some excellent long-term studies that chronicle the changes that occur over time with the chronically unstable knee. Besides the obvious activity restrictions, there is a pattern of ongoing damage to other supporting structures in the knee as well as the long-term development of arthritis. Most of the published studies on nonoperative treatment or delayed treatment of ACL tears come from countries with government run medical systems such as Switzerland, Great Britain and Germany. 

In conclusion, there is a small subset of people that can have an acceptable outcome with the non-operative treatment of tears of the ACL. But, for the vast majority, there are long-term advantages of surgical reconstruction. Protection of the menisci, slowed rate of arthritic changes, and a more predictable return to pre-injury level of activity are benefits of surgical treatment. In my own practice, I treat the acute injury with bracing and a supervised physical therapy program. I delay reconstruction until the pain and swelling have resolved and normal range of motion has been restored, this is usually around three weeks. Following reconstruction, most patients are off crutches in three weeks, out of the brace by six and running at three months. Return to sports such as basketball or soccer is at least six months.

About the author:

Ty E. Richardson, M.D.

Board Certified Orthopaedic Surgeon

Fellowship trained, sub-specializing in orthopaedic sports medicine, arthroscopic surgery of the knee and shoulder, and athletic related injuries

Dr. Richardson is currently the team physician for Manual High School and is a member of several national orthopaedic and sports medicine organizations.

Additional Info:

Originally from Texas, Dr. Richardson attended Baylor University for undergrad, and then went on to University of Texas Medical Branch in Galveston for Medical School. He completed his fellowship in Orthopaedic Sports Medicine at the Hughston Clinic in Columbus, Georgia. At the University of Louisville Dr. Richardson completed his residency where he was involved in extensive research in the arthroscopic treatment of shoulder injuries and ligament injuries of the knee.

In his free time, Dr. Richardson enjoys being active outdoors, including biking, and spending time with his 4 beautiful children.

Louisville Orthopaedic Clinic & Sports Rehab Center

Main Office: 502-897-1794

Physical Therapy: 502-897-1790


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