How bad does my knee pain need to be to get ACL surgery

Do you have knee pain from an ACL tear? Did you recently hurt your ACL and you’re wondering if you’re going to need surgery or not? Or did you hurt your ACL a while back and you’re still having knee pain from it, but you never got surgery?

I’ll explain to you when you should absolutely go get ACL surgery, and when you might be able to wait and hold off on getting that surgery and heal naturally. My name is Dr. David Middaugh, and I’m a specialist physical therapist at El Paso Manual Physical Therapy.

And this channel is dedicated to helping people stay healthy, active, and mobile, while avoiding unnecessary surgery, injections and pain medications. Please subscribe to our channel and hit the bell so that you don’t miss any of the helpful videos that we upload every single week. So let’s get to it, guys.

When should you absolutely get knee ACL surgery? Well, there are four main things you need to look for. If you had an ACL injury, you probably were in some sort of sports accident or an accident, like a car accident, bike accident, somehow you got a trauma to your knee.

In rare circumstances, it does happen though, it is possible to get an ACL tear, without ever having a trauma. It’s just a repetitive, bad use of your knee. Unknowingly, of course. That ends up tearing and stretching out the ACL. But there are four signs to look for.

The first sign is no improvement in pain. Let’s say you got your injury a week ago, or two or three weeks ago, or even longer than that. Say it’s been two months, and you have not improved. You’re about the same, compared to when you first got injured, those first few days afterwards. That is not good, if there is no sign of it improving. So you might go get an ACL surgery in that case.

Associated with this, the second sign, you’re going to see is swelling. Swelling, that doesn’t go away. It just stays swollen. It feels like it’s not really gone down ever. You may have wrapped it or put on a brace or something. And it feels like it doesn’t really ever go down at all. That’s also a bad sign. You’re going to want to go get an ACL surgery if that’s the case for you.

Number three, the knee buckling or giving way. And what I mean by this, I had some people on our channel, asking what knee buckling is. So I’m just going to explain here real quick. So this is a knee joint right here. Here’s the foot, that’s the shin, there’s a kneecap and we’re looking at the right knee.

If you’re standing on your leg, I’ll give you a side view here. And you feel like all of a sudden, your knee bends backwards, like it just gives, you can’t stand on it, supported the way you normally do. It just kind of makes you do that, then that’s knee buckling, that’s giving way. And what happens is you lose stability for a moment; the muscles aren’t very strong and holding it up. And so the joint just buckles, it gives way.

If you’re experiencing this buckling consistently, like several times a day, every hour, that kind of thing, then it’s not a good sign, it means that you’ve got some serious loss of stability in your knee joints.

Now I can’t give you a specific number on, you know how many times a day this is happening, and that equals go get surgery. It really is to your tolerance and how much you can overcome with strength, if you’re going to end up not having surgery will speak more to just keep watching the video and I’ll get to that part. The fourth signs if you’ve gone to go get an MRI, and you have a confirmed ACL tear.

Now what you have to proceed with this cautiously, the research does show that there’s a probability of a false positive on your MRI, meaning you were told that you have an ACL tear. So that’s a positive sign that you have an ACL tear, but it was a false positive because an MRI is just a picture of the inside of your knee taken with this big machine. The magnetic resonance imaging machine in it and then looking at the inside of your knee, it’s not the best picture.

The number one gold standard for diagnosing an ACL tear is surgical observation. So they have to go inside your knee surgery, and then look at your ACL and tell you “Oh yeah, it’s torn or no, it’s not torn”. But of course, we’re not going to do that if you have a possible connective ACL, because then you’re already having surgery at that point.

But if you’ve got all of these signs just to review them pain that doesn’t get better swelling, that doesn’t get better, knee buckling or giving way. And then you’ve been told that you have a torn ACL on your MRI, there’s a darn high likelihood that you probably need surgery in this case.

Now fifth condition that I would look at, because I have had patients that I’ve had all of these signs, and they’ve gotten better without surgery. But the one deciding factor in these patients is I asked them, how active are you? I mean, are you going to be doing competitive sports? Are you, is there a potential that you’re going to be doing dynamic activities like sports, like soccer, basketball, where you’re going to be changing directions.

Football, American football, if you’re going to do any of these sports and it requires you quickly cutting and changing directions, then you need a lot of stability in your knee and it’s a no brainer you need to go get an ACL surgery done.

The techniques these days are fantastic the recovery is it is what it is. It takes time but you people just generally do pretty good with ACL reconstruction surgery. But if you’re going to be active, just go get the surgery and go through the recovery.

Now, if you’re not planning on going to be super active, if you’re thinking, I’m just going to be a regular gym goer, I might run I might be on the treadmill, the elliptical, I might lift weights, I’m not going to do anything crazy. I’m not going to be changing directions in my sports, maybe occasionally here and there, but nothing consistent, then you have an excellent shot at rehabilitating or fixing your knee problem with his ACL tear without surgery.

So let’s talk about when you should wait to see if you can recover without getting a knee ACL surgery. If you had your injury a few weeks back or months ago, and you feel like the pains gotten better and better as the weeks have gone by, maybe it’s just not fully gone. It’s kind of plateaued. But you’re a lot better than when you first hurt your knee or those first couple of weeks afterwards, that’s a good sign that you might be able to get away without surgery. Same thing with the swelling.

The second sign is if your swelling has gone down immensely, and you feel like it’s relatively more like the other side, now there might still be some residual swelling, then that’s also a good sign, that means your swelling has gone under control.

Commonly, there’s still a little bit of pain and swelling. And people that have had ACL injuries and have not had surgery, there’s just some things that they haven’t figured out in order to get the stability that they need, either with a brace or through exercise or to the proper treatment, so that they can fully recover their ACL without having surgery.

Now let’s talk about knee buckling. The third sign, like I said just before, if you have that consistently buckling, like it’s happening every day, you can expect it to just bother you throughout the day that’s consistently buckling. If it’s inconsistent, like it happens a few times a week, or maybe even just a few times a month, when you’re more tired.

Or if you’re doing something a bit more strenuous, then there’s a good chance that you can get away without having surgery because you’ve got more control from your muscles, and you actually have a decent amount of stability in your knee. You’ve just got to get the remaining amount of stability from by healing your ACL.

You’re now the fourth sign going back to the MRI, if you went to go get an MRI, and they told you that you have a partial ACL tear, I can tell you I would not get ACL surgery, there’s an excellent chance that if you do everything right, if you go to the right treatment, you can heal without having surgery.

Again, going back to those false positives, you can have false positives going either way, you can have a false negative as well. MRIs are just not the greatest at seeing on the inside of the body. And you know, I say that with a grain of salt. MRIs are fantastic machines, they have improved the medical industry, the whole medical field and the health of the world tremendously.

I’m just saying that when it comes to ACL diagnoses, ACL tears, they’re not 100% there, they’re not bad, but they’re not 100%. I have had some clients tell me that they ended up getting an ACL surgery, when they were told that they have an ACL tear based off the MRI.

And when the surgeon went in to do the surgery and visually inspected the ACL, which is the gold standard. And it wasn’t completely torn, there was a partial tear. But since the surgeons in there, it’s actually ethical for him to cut the ACL and repair it fully because he’s already in there. He already made the incisions, the whole hospitals ready to go the surgical theatres ready to go. So they’re going to fix your ACL and make it as strong as possible because they’re doing their due diligence in that in that case.

But what’s going through the back of the patient’s mind is did I have to go through all that could I have just avoided it had I not signed up for surgery. Now if you’re in this boat, if you if you find that your pain has gotten better, your swelling is getting better, they told you that you had a partial MC ACL tear, and you’re really not buckling that much. And maybe it happens from time to time, but it’s not that bad for you, then you have an excellent chance at healing without surgery, you’ve got to get a brace on.

Now I’ve linked a video down in the description below about how to choose the right brace for you. I’ve also linked a brace that we recommend on there, it’s a affiliate link in there so we get a little commission for it.

But this brace gives you the right compression it compensates for the lack of stability. And if you get one similar to it, that’s fine too. I just want you to get in a brace if you’ve got an ACL tear. The other thing that you need to think about is what exercises to do. I’ve put a video in there.

And I’ve also got a video that talks about how to test it yourself at home in case you’ve never seen a doctor and you’re wondering if your knee pain is coming from an ACL tear, you can check out that video to begin to get an idea for what exactly is causing your knee problem.

Now let me tell you what you should expect to be able to get back to doing if you heal naturally from your ACL. You should be able to do all your activities at home you should be able to go up and down stairs just fine and even exercise as frequently as you like just as long as you take it easy gradually progressing into exercise like everybody should anyway. You should never jump into exercise too fast.

But you’ve got to realize that is it, what you’ve got to realize is that if you’ve had an ACL tear in the past, then your ACL is going to be weakened. And when it heals, it heals with scar tissue, which is a good thing. It’s just that the scar tissue isn’t as strong as your original tissue. It’s about 70 to 80% as strong as what we what we think in the medical field.

But if you go exercise, the tissues gradually gets stronger, as long as you don’t overdo it. So if you decide that you want to take up running, you should be able to just fine, just start slow, you know, slow and not that far, and gradually increase your speed and as well as the distance that you’re traveling.

When you go on a run, you should be able to lift weights, in fact, you should get quite good stability. When you’re lifting weights as long as you’re not going crazy with the weights and putting yourself in in bad situations where you’re going to lose a lot of stability and your knees. If you plan to take on walking for exercise, it shouldn’t be a problem.

And if you plan to be a regular gym goer, just to go use the machines, the cardio machines or the weight machines that should be just fine for you if you choose to not have surgery. Hey guys, I hope this video was helpful for you please give us a thumbs up and don’t forget to subscribe and hit the notification bell so that you don’t miss out on any of the helpful videos. We post every single week. Catch you next time.