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When Does A Partial ACL Tear Require Surgery?

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Updated May 25, 2012

Question: When Does A Partial ACL Tear Require Surgery?
ACL injuries can either be complete or partial. When there is a partial ACL tear, a difficult decision about surgery needs to be made. An ACL reconstruction involves significant rehabilitation, and other operative risks. Deciding when ACL reconstruction is necessary can be a difficult problem, especially when the ACL is only partially torn. So how do we decide when to reconstruct a partially torn ACL?
Answer: Treatment of an ACL tear is most dependent on how much knee instability is caused by the injury. Therefore, there is no critical cutoff (i.e. 50%) for determining when ACL reconstruction surgery is necessary in the setting of a partial ACL tear. Rather, the decision should be based on a combination of symptoms (instability, episodes of 'giving way,' etc.) and physical examination findings (Lachman test, pivot-shift). If there is instability perceived by the patient, and physical exam findings consistent with laxity of the ACL, then reconstruction is a reasonable option.

Unfortunately, incomplete tears of the ACL are difficult to assess. When looking at an injured ACL during an arthroscopy, your surgeon can assess the look and feel of the ligament to make an assessment on the extent of the injury. However, this look and feel method of assessing an ACL is very subjective. Not everyone will agree on what looks good and what looks bad. The better method of assessing a partial ACL injury is based on the aforementioned symptoms and examination findings.

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  8. Partial ACL Tears

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