The same is also true if your knee is unstable as a result of the injury. At the other extreme, if you are over 40 years old, symptom-free, and all your athletic activities are of the low impact, straight-ahead variety, such as cycling, swimming, and intermediate hiking, surgery is not necessary.

Everyone in between presents a dilemma.

You have to weigh the risk of surgery against the risk of perhaps being at increased risk for arthritis in the future.

When Should Surgery be Performed?

Is it better to operate on the knee when it has just been seriously traumatized or is it better to wait for the knee to have recovered somewhat before assaulting it again? You can argue this all day. Needless to say, orthopedists in ski resorts see things somewhat differently from their colleagues in the cities. As a city orthopedist, I would rather let the athlete adjust to the physical and emotional aspect of the trauma, let him or her collect their wits, search the Internet, make the appropriate work/school arrangements, rehab the knee to get reasonable strength and motion back, and then peacefully and carefully reconstruct the ligament. In cities, as in mountains resorts, a number of orthopedists use the shoe salesman approach: sign up the patient for surgery right away, or risk losing the customer.

Types of Surgery

When something is torn, the natural reaction is to sew it back together. Therefore, the earliest operations for a torn ACL involved sewing the torn ends. This did not work. Perhaps the techniques were inadequate or perhaps a stretched and torn cable-like structure is simply not amenable to sewing. In any case, the current party line is that an ACL cannot be fixed. If instead of being torn, the ligament has been pulled off at its origin on the thighbone, some will argue that it can be reattached to its origin, much as an anchor can be pushed back into the sand after it has been pulled out. But this is not accepted practice, which is not to say that it is wrong.