“Dodging a bullet” - ACL surgery cancellations during the COVID-19 crisis

Apr 20

Why cancelling your ACL surgery due to COVID-19 was a blessing in disguise!!

With the current COVID-19 shutdowns on non-essential elective surgeries, many ACL injured patients have been left wondering how they will recover after their scheduled surgery has been cancelled.

Here’s why you should consider it a blessing in disguise.

Firstly, there’s a reason these surgeries are being cancelled, and its because they are non-essential, and non-urgent! Although your ACL injury may be very painful and may cause significant short-term disability, it is not life-threatening, and actually has a good natural history. With a bit of time your pain will likely subside, and your function will improve.

Secondly, there’s a good change (between 50 and 77%) that you can recover to pre-injury capacity without surgery, even if you participate in high level sports like soccer, football, skiing, etc. (Dhillon, 2014; Frobell, 2013; Grindem, 2018).

Even if you have other ligamentous injuries, meniscal injuries, bone bruising, chondral injuries, surgery is not urgent nor necessary in most cases.

You may even consider you’ve dodged a proverbial bullet. Many recent studies have found that early reconstructive surgery, before a comprehensive rehabilitation program has been completed, leads to poorer long term outcomes, increased knee inflammation and risk of osteoarthritis, greater risk of graft failure, and doesn’t allow for the real possibility that the ACL could heal! (Filbay, 2017; Grindem, 2015; Larsson, 2107; Ihara and Kawano, 2017; Marangoni, 2018; Nordenvall, 2014; Rahardja, 2020; Wang, 2020).

So now that you’re now that you’ve dodged that bullet, what should you do?

Begin with worlds best practice and commence a graded, comprehensive, supervised rehabilitation program with the purpose of regaining knee and lower-limb function, and continue for a minimum period of 3 to 6 months, at which point there is a 50 to 77% chance that surgery won’t be necessary!

References

1. Dhillon, 2014 - https://www.ncbi.nlm.nih.gov/pubmed/26401236

2. Frobell, 2013 - https://www.ncbi.nlm.nih.gov/pubmed/23349407

3. Grindem, 2018 -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968666/

4. Filbay, 2017 - https://bjsm.bmj.com/content/51/22/1622

5. Grindem, 2015 - https://bjsm.bmj.com/content/49/6/385

6. Larsson, 2017 - https://www.ncbi.nlm.nih.gov/pubmed/28522220

7. Ihara and Kawano, 2017 - https://www.ncbi.nlm.nih.gov/pubmed/28045756

8. Marangoni, 2018 - https://journals.sagepub.com/doi/abs/10.1177/2325967118S00204

9. Nordenvall, 2014 - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0104681

10. Rahardja, 2020 - https://www.ncbi.nlm.nih.gov/pubmed/32014408

11. Wang, 2020 - https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-020-02156-5