ACL Surgery Alternatives

Ross Hauser, MDRoss Hauser, MD

The MRI says I have a complete tear, I guess I need surgery

Maybe not. “MRI studies have not been shown to be accurate in the differentiation of complete and partial ACL tears.” This is from “the bible” of MRIs and sports medicine.(1) If athletes would just hold off on surgery until evaluated and treated with Prolotherapy, there would be a lot less of them needing pain pills, knee replacement surgery, and wheelchairs and canes later in life.

ACL Surgery Alternatives

In the surgical mode of options, the best case scenario for a torn ACL is that athletes are told that a tendon can replace the ligament and the rehabilitation of this new structure takes a full year. Perhaps then, the athlete will be able to compete again at a later date. The other option of course in this mode of options is do nothing, rest the injury to see if the ACL responds.

Left untreated ACL injuries have terrible consequences and, if treated with surgery there are bad consequences. Unfortunately for the athlete unaware of Prolotherapy, they must choose between the lesser of two evils.

The Untreated ACL

Studies have shown:

  1. up to 86% of these knees “gave way” within four years.
  2. only 14% of athletes were able to return to unlimited athletic activities.
  3. after ten years, up to 78 percent of the knees treated without surgery showed Osteoarthritis.
  4. ACL deficient knees are plagued by long term swelling and stiffness.

Realize that the conservative treatments the athletes received in the above studies were Rest, Ice, Compression, and Elevation (RICE treatment), anti-inflammatories, cortisone, physical therapy, and other conservative therapies. They did not receive Prolotherapy.

What about ACL Surgery?

There are various surgical techniques employed in the ACL reconstruction: repair through the patellar defect, arthroscopically-assisted techniques, and the mini-arthrotomy technique. The problem is that the orthopedic surgeons’ views on excellent results is different than the athletes’ views. The athlete is thinking “I’m going to be back to my sport as good as new as soon as the surgery is over.” The orthopedist is thinking, “This athlete doesn’t have a chance to be back on that ball field, but the surgery will help stabilize the knee.” Poor communication is at the crux of this. The final goals and desired outcomes are never discussed.

Prolotherapy and ACL Tears. What is Realistic?

In a partial tear, Prolotherapy can be done exactly where the ACL attaches onto the tibia and femur, thereby stimulating the ligament on both ends to proliferate and strengthen. It is only then, by the strengthening of the ACL, will the athlete truly be healed.

Prolotherapy can cure a partial ACL tear, but not a complete tear. A complete tear requires surgery. Prolotherapy is still helpful in this situation, because the other ligaments around the knee, as well as the joint capsule itself, were at least stretched during the forceful event to the knee that totally disrupted the ACL. Strengthening the surrounding connective tissue will help disperse the load on the rebuilt ACL.

1. Stoller, D. Magnetic Resonance Imaging in Orthopaedics and Sports Medicine. Second Edition. Philadelphia, PA: Lippincott-Raven, 1997, 330.