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When Does an ACL Tear Require Surgery?

ACL Tear

ACL injuries are common in the sports world, but you can also sustain this type of injury from a car accident or other trauma. Our board-certified orthopedic surgeons at Sports Medicine Oregon frequently perform ACL reconstruction on patients who need surgical repair. Not all ACL tears require surgery to heal. Learn when an ACL tear needs surgery. 

What is an ACL tear? 

Your anterior cruciate ligament (ACL) goes from the back of your leg to the front through the middle of your knee. It helps keep your tibia — the smaller of two bones between your knee and ankle — from slipping in front of your thigh bone. It also helps keep your knee in place when you rotate your leg side to side and when you run or jump. 

For example, if you play tennis, your ACL keeps your knee stable when you pivot quickly on the court to hit a shot. Wear and tear by an active player can lead to a tear. In basketball, if your knees come together at the end of a jump, your shin bone can rotate, placing your ACL under undue stress, leading to a tear.  

An ACL tear is a second- or third-degree sprain. If you have a second-degree sprain, you have a partial ACL tear. A third-degree sprain means your ACL is completely severed. 

You likely felt intense pain and may have heard a “pop” in your knee when the tear occurred. Your knee and the area surrounding it are swollen. You may not be able to walk or bear weight on the affected leg at first. 

When does an ACL tear require surgery?

Following are instances in which your surgeon may recommend an ACL reconstruction

Individuals with active lifestyles and/or physically demanding jobs 

After initial conservative treatment to calm the pain and inflammation, your Sports Medicine Oregon orthopedic surgeon talks with you about the activity level you want to have once the injury has healed.

No matter what age you are, if you play competitive sports and want to continue to play at or near the same level, ACL surgery is required if you have a significant tear. You’re on the court pivoting, jumping, or running frequently so you need a strong, stable knee. 

Likewise, if your job involves hard manual work that includes lifting heavy objects and frequent turning and pivoting, you need adequate knee support. Carpenters, roofers, loggers, warehouse workers, and others in physically demanding jobs will benefit from surgery. 

Knee instability 

If your tear results in major knee instability, you’ll need surgery to repair it. An unstable knee can lead to falls and other accidents. Even if it doesn’t, it may lead to additional damage to your knee, requiring more repair work in the future than going ahead with the surgery in the months after the injury first occurred. 

Your Sports Medicine Oregon orthopedic surgeon may perform a couple of tests to determine whether you have an ACL tear and knee instability. You’ll lie still on a table while he manipulates your knee and leg. If you’ve already felt the knee giving way, that also is a major factor in your physician’s decision about surgery.

Other ligament and menisci damage


An ACL tear usually occurs with other collateral damage, including damage to other ligaments; your meniscus, which is the cartilage that provides a cushion between the bones; and the protective capsule surrounding the knee joint. Some meniscus tears can be repaired. Healing may be better when corrected during surgery for ACL reconstruction. 

Your physician normally selects a hamstring graft for ACL repairs. Research indicates patients have less pain and fewer complications after surgery

Call or book an appointment online with Sports Medicine Oregon today if you have knee or other musculoskeletal pain.

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