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Knee Surgery Looks No Better Than Therapy For Torn ACL

An anatomical drawing of the knee

If you tear your ACL, you might try vigorous rehab before heading to surgery. Wikimedia Commons hide caption

itoggle caption Wikimedia Commons

You're young, fit and in pain after tearing one of the key ligaments that holds your knee together.

What do you do? Patients and their orthopedic surgeons often rush to reconstruct the anterior cruciate ligament, or ACL, figuring that rebuilding it right away is the best approach to stabilizing a creaky knee.

There's just one problem: Nobody has proved that surgery is better than rehab. And in the U.S. alone, more than 200,000 ACL reconstructions get done each year — to the tune of $3 billion.

Enter some Swedish researcher who persuaded 121 young folks, almost all of whom tore their ACLs playing some sort of sport, to be randomly assigned to treatment with rehab and early surgery or a rehab-focused approach, with an option for surgery if needed.

Turns out the aggressive surgical approach was no better than then rehab-oriented path. After two years, the results for both groups were about the same when it came to things like pain and functions of daily life. Oh, and there were 61 percent fewer surgeries in the rehab-focused group.

The findings appear in the latest New England Journal of Medicine.

Now it has to be said that both groups had plenty of problems afterward, such as knee pain and swelling. And a majority of the people assigned to the rehab-focused group said their injured knees were wobbly.

Still, the researchers conclude that emphasizing rehab and offering surgery as an option down the road could substantially reduce the number of ACL reconstructions performed without harming the ultimate results for patients.

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