Partial ACL rupture. Repair or not?

Hi there fellow physios (and others). I have continued to notice that everytime a client with an ACL injury presents to a UK NHS hospital they are told they need surgery for a reconstruction. They are told this with or without MRI.

What I am wondering is whether partial ruptures are simply being cut out so surgeons can practice their reconstruction techniques. Would the client not be better with some reminent ACL attachment that might provide some feedback on joint movement? If so, at what stage would a rupture be considered worthy of reconstruction? Should all be reconstructed? I am not currently aware of any guidelines/protocols that direct doctors on this issue.

Any and all feedback welcome... <img border=0 src="http://www.ezboard.com/images/emoticons/nerd.gif" />

Some guidelines I have seen are:
who should be reconstructed?
fit young active people involved in sports with cutting/pivoting or have physical job,
more sedentary people if c/o giving way,
good prehabilitation 45 min cycling pain free.

Natural history: 44 pts ACL rupure meniscus normal, 30% marked instability and unable to play, 70% return to play average 5.7 wks, 61% who returnied to play had reconstruction within a year

Hope this helps

Injuryupdate.com.au has a good summary:

Partial tears often will progress to complete tears.

Reconstruction is considered when:

- multi-directional demands in chosen sport

- instability in the knee (on examination or functionally)

- long term benefits: willing to risk a degenerative knee?

:)

Hi guys,

i'm 22 and a very active sportsmen.. i play rugby (club level), football/futsal (college level) and tennis/badminton (occasional)..

He asked me to do some self physio such as cycling and swimming for rehabilitation. a need for immediate surgery was not neccesary in late nov 2011 i partially torn my ACL at rugby training while i was side stepping.. went to see the specialist & got myself an MRI scan.. the doctor confirmed that it was a partially torn ACL..

an immediate surgery isnt necessary.. since i'm still doing my internship, the specialist gave me time to regain strength and rehab my knee before the next check-up.. if there is still signs of instability, a full reconstruction may be required.. after 2 months of occasional swimming, cycling & weights training, i do have full motion of my knee but it still hurts at times..

My questions are:
1) can anyone define "instability"?
2) is there much benefit of "arthroscopy"? *arthroscopy: trimming out the torn portion
3) after rehab, the chances of turning a partial tear into a full tear is there. does strapping tape help in anyway during sports?
4) after a complete reconstruction, does the possibility of the same injury increase, maintain the same or decrease? Is the new ACL stronger, the same or weaker than the original ACL?
5) trough the thread, there are contradictions between PTs and patients.. PT says use what u hv left (use it until fully torn with possibility of MCL injuries as well), patient says straight reconsruction.. can anyone verify who to follow?

hope someone can help out.. really want to get back on to the field.. a young man that really wants to get back on his feet..