Is Surgery Always Necessary After a Cruciate Ligament Injury? A Doctor’s Guide to Phased Decision-Making and Rehabilitation Training
Update Date：2025/06/04，
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Sports Medicine and Smart Recovery Center
The knee joint’s stability is maintained by multiple ligaments, among which the anterior cruciate ligament (ACL) is one of the most important structures. It acts like an internal seatbelt for the knee, preventing the tibia from sliding excessively forward. ACL injuries are common in high-impact sports involving jumping, sudden stops, and quick changes of direction, such as basketball, soccer, or skiing, making it a nightmare for many young athletes.
Is immediate surgery always necessary after an ACL tear? Not necessarily. Depending on factors such as the patient’s age, activity level, and knee stability, sometimes non-surgical conservative treatment may be more appropriate.
What to do after an ACL injury?
When the anterior cruciate ligament (ACL) is injured, the most common symptoms include:
1. A sudden "pop" sound in the knee followed by weakness and collapse
2. Rapid swelling of the joint
3. A feeling of looseness or instability when moving, or inability to bear weight
4. Difficulty performing movements such as turning, changing direction, or jumping
Through clinical examinations (such as the Lachman test) and magnetic resonance imaging (MRI), doctors can determine whether the ligament is partially torn or completely ruptured.
Surgery is not the only option: These patients may not need surgery
For patients with low activity levels or no feelings of knee instability, doctors may recommend starting with conservative treatment, which includes:
• Stability training
• Strengthening the quadriceps and gluteal muscles
• Using knee braces or supports to stabilize the joint
The following groups may be suitable for non-surgical treatment:
• Older adults who do not engage in strenuous activities
• Patients with ligament tears but stable knee joints
• Patients with other complications that make surgery unsuitable
• Patients highly motivated and able to participate in a comprehensive rehabilitation program
• Patients with more severe joint degeneration
Studies have shown that these patients can still achieve good functional recovery and maintain quality of life through intensive physical therapy.
Who is recommended to undergo ACL reconstruction surgery?
Doctors may recommend ACL reconstruction surgery if any of the following conditions occur:
• Young age, high activity level, or being an athlete
• Multiple ligament injuries combined (such as meniscus tears)
• Knee instability affecting normal walking or work
• Conservative treatment is ineffective or rehabilitation progress is limited
The most common surgical method currently is arthroscopic ligament reconstruction, which uses either the patient’s own tendon or an artificial ligament to replace the damaged structure. This procedure is minimally invasive and has a relatively quick recovery time.
Recommended Phases of ACL Postoperative Rehabilitation
Regardless of whether surgery is performed, subsequent rehabilitation training is absolutely crucial. The Sports Medicine Center designs individualized training programs based on each patient’s condition, aiming to restore knee stability, muscle strength, and proprioception.
The ACL rehabilitation process can generally be divided into four phases:
• Initial phase (1–4 weeks post-surgery): Control swelling, restore knee extension, and perform simple muscle contraction exercises
• Intermediate phase (1–3 months): Strengthen muscles, increase range of motion, and gait training
• Functional reconstruction phase (3–6 months): Coordination exercises, jump training, and core stability training
• Return-to-sport phase (after 6 months): Simulated sports movements, acceleration and deceleration training
At the Tri-Service General Hospital Sports Medicine and Intelligent Recovery Center, we combine advanced technologies such as electromyography (EMG) analysis, motion capture systems, and anti-gravity treadmills to assist patients in monitoring their recovery progress and conducting advanced exercise testing, ensuring a safe return to sports and active life.
Professional Advice: The Decision Is Not “Whether to Have Surgery,” But “What’s Best for You”
Management of ACL injuries should not be based solely on MRI findings. A comprehensive evaluation considering overall function, age, lifestyle needs, and feasibility of rehabilitation is essential. Physicians, together with the rehabilitation team, will determine the best treatment plan tailored to each patient’s individual situation.
If you experience a knee sprain or suspect an ACL injury, it is recommended to seek evaluation and planning at a sports medicine center as early as possible. Early intervention helps reduce the risk of long-term instability and joint degeneration.