On the weekend, Principle Four Osteopathy was fortunate enough to have Mick Hughes present on the treatment options following an ACL injury. Mick has completed his post-graduate masters in sports physiotherapy and has a special interest in the diagnosis, management and prevention of sports injuries, in particular knee injuries.

It is widely believed throughout the medical and general population that an athlete MUST undergo an ACL reconstruction following an ACL rupture, especially if the athlete wishes to return to their sport. However, Mick was here to challenge our views and present the research on non-operative management of an ACL injury.

When comparing the treatment options, it is critical to consider two important questions:

  1. Is it possible for an athlete to return to their pre-injury level of sport without an ACL reconstruction?
  2. Does the non-operative treatment option increase the chance of the athlete developing osteoarthritis?

Using several reputable research papers (including the KANON Trial), Mick was able to demonstrate the outcomes of athletes who had an ACL reconstruction compared to those who received non-operative management. The non-operative management group instead underwent a comprehensive rehabilitation program.

Mick’s major points are listed below:

  • Consistent findings across several cohort studies show that non-operative ACL patients (even elite athletes) do just as well as ACL reconstruction patients in short and long term outcome measures.
  • Regardless of eventual treatment choice, ACL patients will benefit from at least 5 weeks of high quality strengthening rehabilitation.
  • Osteoarthritic changes are likely to occur regardless of treatment option; however, it needs to be reinforced that there is no significant difference between treatment groups from baseline to 5 years in regard to radiographic osteoarthritis.

In conclusion, it is important for ACL patients (absence of high-grade concomitant injuries) to know that they have a choice in regard to their treatment option, and a reconstruction is not always required.


  1. Richard B. Frobell, Ewa M. Roos, Harald P. Roos, Jonas Ranstam, & L. Stefan Lohmander. (2013). Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ.