Anterior Cruciate Ligament (ACL) injuries are common, especially in athletes and people who lead an active lifestyle. Commonly treated with surgery, the recovery process can be long and complex, depending on the size and severity of the injury.
Deciding when to undergo surgery after an ACL injury can be a difficult decision, influenced by various factors such as age, activity level, and the extent of the injury. It’s understandable to want to delay surgery, but it’s also important to know the risks.
Here we explain the potential risks of delaying surgery, and whether there are ever any benefits to delaying the procedure.
Postponing ACL repair shown to cause medial chondral injuries
In one study, the effects of delaying ACL reconstruction surgery for more than 12 months were examined. It found that patients who postponed surgery beyond a year had a significantly higher risk of developing medial chondral injuries (damage to the cartilage on the inner side of the knee joint).
Cartilage cushions the knee and keeps it moving smoothly. When the ACL is torn, the knee becomes unstable, increasing the likelihood of additional injuries to the cartilage and meniscus. The study suggests that prolonged instability due to a delayed surgery can lead to degenerative changes in the knee, potentially resulting in arthritis and long-term functional limitations.
So, for those experiencing knee instability or engaging in activities that put stress on the knee, early surgery could be beneficial to protect the integrity of the joint.
The dangers of delaying surgery in younger patients
Another study published in the Orthopaedic Journal of Sports Medicine, focused on the impact of delayed ACL surgery in younger patients. It found that children and adolescents who postponed surgery were at a higher risk of sustaining additional injuries, such as meniscal tears and cartilage damage.
Younger people tend to be more active and may continue participating in sports or physical activities despite an ACL injury. This continued activity on an unstable knee can exacerbate the injury and lead to further complications. Early surgical intervention in younger patients can prevent secondary injuries and promote better long-term outcomes.
When delaying surgery may be beneficial
While early surgery has its advantages, some studies suggest that immediate surgery isn’t always the best course of action for every patient. Research published in the Journal of Orthopaedics and Traumatology suggests that performing ACL reconstruction within three months of injury may increase the risk of needing a revision surgery later.
The study found that patients who had surgery less than three months after their injury had a higher incidence of stiffness and required additional procedures to address complications. Delaying surgery slightly allowed time for inflammation to subside and for patients to regain a better range of motion before the operation, which can lead to improved surgical outcomes.
For some adults, especially those who are less active or engage in lower-impact activities, non-surgical management combined with physical therapy may be a viable option. Strengthening the muscles around the knee can improve stability and function without the need for immediate surgery.
Deciding on the timing of ACL surgery is a personalised decision that should be made in consultation with an orthopaedic specialist. It’s essential to weigh the potential risks and benefits of both early and delayed surgery.
If you’ve suffered an ACL injury and are unsure about the right time for surgery, schedule an appointment with leading orthopaedic surgeon, Mr Shah Punwar.
