Hyderabad: Till recently, almost all the sports rehabilitation specialists and orthopaedics in the country used to advise mandatory surgery to professional and amateur sportspersons who suffered a torn Anterior Cruciate Ligament (ACL), the strong tissue that connects thigh bone (femur) to the shinbone (tibia).
However, a major study that was published in the British Journal of Sports Medicine in November on ACL tears has literally rocked the field of sports medicine and orthopaedics.
The study, which was led by physiotherapist and Senior Research Fellow from University of Melbourne, Dr Stephanie Filbay, demonstrated that there is no need for conducting a surgery for an ACL tear. On the contrary, the ACL tears can be repaired and rehabilitated through exercise alone. The new findings have challenged the common notion that an ACL injury cannot heal and requires surgery.
The study said that exercise-based rehabilitation can help persons to recover from their ACL tear and there is no need for a surgery. The study analysed trial data and found evidence that ACL tears can heal through rehabilitation. This is not all! The study also reported that those patients who underwent ACL rehabilitation and not surgery have experienced better recovery.
About 53 percent of clinical trial participants in the study, who had ACL ruptures, received exercise-based rehabilitation and they refused to have ACL surgery because they healed naturally after undergoing rehab.
“The MRI appearance of ACL healing after ACL rupture occurred in one in three adults randomised to initial rehabilitation and one in two who did not cross-over to delayed ACLR and was associated with favourable outcomes. The potential for spontaneous healing of the ACL to facilitate better clinical outcomes may be greater than previously considered,” the researchers in their study said.
What is ACL reconstruction?
Typically, ACL reconstruction is a surgery that replaces the torn ACL ligament in the knee with a healthy tendon. Usually, a healthy tendon can be taken from multiple places like hamstring graft where the tendon is taken from patient’s hamstring. Sometimes, a healthy tendon is also taken from Patella, quadriceps and sometimes tissue is also taken from a tissue bank from a cadaver donor.
The ACL injuries usually occur while playing sports especially those having quick direction changes, jumps, fast running and sudden stops like badminton, volleyball, basketball, hockey, and football.
The ACL injuries happen when the ACL gets stretched to its limit. As a result of this massive stretching, the ACL tissue tears, thus impacting the connection between thigh bone and tibia, causing instability in the knee. A tear or damage to ACL makes quite painful for individuals to run, jump, and even walk.
It’s a long journey for individuals to recover from ACL tears. Following the surgery, depending on the condition of the patients, it takes at least six months to even a year to fully recover the normal range of motion of the knee. Worldwide, including India, ACL reconstruction surgery is the most common treatment for ACL tear or ruptures.
Exercise contributes to tissue regeneration
A paper titled ‘Molecular mechanisms of exercise contributing to tissue regeneration’ which was published in the prestigious Nature journal this November by a group of researchers has thrown some light on how ACL tears can repairs on its own through just exercise-rehabilitation.
Physical activity has been known as an essential element to promote human health for centuries… Exercise has been expected as a candidate approach of alleviating a wide range of diseases, such as metabolic diseases, neurodegenerative disorders, tumors, and cardiovascular diseases. In particular, the capacity of exercise to promote tissue regeneration has attracted the attention of many researchers in recent decades. Since most adult human organs have a weak regenerative capacity, it is currently a key challenge in regenerative medicine to improve the efficiency of tissue regeneration,” the researchers said.