Necessity of surgery after an ACL tear

An anterior cruciate ligament (ACL) tear can be a physically devastating injury, but its impact goes beyond the realm of the physical. The psychological toll of an ACL injury, coupled with the decision-making process regarding the necessity of surgery, can be a challenging journey for individuals facing this ordeal.

The Emotional Blow:

An ACL tear often comes as an unexpected blow, particularly for athletes who rely heavily on their physical prowess. The initial shock and disbelief are accompanied by a wave of emotions – frustration, anger, and disappointment. The sudden restriction on mobility and the potential sidelining from sports or activities that one loves can lead to feelings of loss and helplessness.

Uncertainty and Decision-Making:

The crucial decision of whether surgery is necessary adds another layer of complexity to the emotional rollercoaster. Individuals are faced with a dilemma: opt for surgical intervention or explore non-surgical alternatives. This decision is influenced by various factors, such as the severity of the injury, lifestyle considerations, the pursuit of long-term joint health, and whether the patient can cope without an ACL in activity. The necessity of surgery after an ACL tear becomes a pivotal point in the journey toward recovery.

The Fear of the Unknown:

The prospect of surgery, with its inherent risks and uncertainties, can trigger anxiety and fear. Questions about the success of the procedure, the post-surgery rehabilitation process, and the ability to regain pre-injury levels of activity can haunt the minds of those contemplating surgical intervention. The fear of the unknown can be paralyzing, impacting not only the individual’s mental state but also their overall well-being.

Impact on Mental Health:

The psychological impact of an ACL injury is not confined to the immediate aftermath; it extends throughout the recovery process. The fear of reinjury, coupled with the frustration of a potentially prolonged rehabilitation period, can lead to feelings of anxiety and depression. The inability to participate in once-loved activities and the fear of losing athletic prowess can contribute to a negative self-image.

Importance of Support Systems:

Navigating the psychological challenges of an ACL injury and the decision-making process surrounding surgery necessitates a robust support system. Family, friends, coaches, and healthcare professionals play a crucial role in providing emotional support, information, and guidance. Establishing open lines of communication can alleviate some of the emotional burden and assist in making informed decisions about the necessity of surgery.

The Psychological Upside of Surgical Intervention:

While the psychological impact of an ACL injury can be profound, there is a silver lining for many individuals who choose surgical intervention. The decision to undergo surgery represents a proactive step toward recovery and can instill a sense of control over one’s destiny. The anticipation of returning to pre-injury levels of activity and the positive impact on mental well-being can act as powerful motivators throughout the rehabilitation journey.

Ways to handle an injury courtesy by Pursuit Physiotherapy (Read the caption)

The Psychological Rollercoaster: Navigating the Necessity of Surgery after an ACL Tear with Physiotherapy

As individuals grapple with the emotional aftermath of an anterior cruciate ligament (ACL) tear and the daunting decision-making process regarding surgery, there exists a beacon of hope: physiotherapy. Beyond being a crucial element in the recovery process, physiotherapy plays a pivotal role in alleviating the psychological impact of an ACL injury, offering an alternative path for those deliberating the necessity of surgery.

Understanding the Role of Physiotherapy:

Physiotherapy, or physical therapy, involves a targeted rehabilitation program designed to restore function, mobility, and strength following an injury. In the context of an ACL tear, physiotherapy becomes a cornerstone of both conservative management and post-surgical recovery, providing individuals with an opportunity to regain control over their physical well-being and, consequently, their mental state.

Early Intervention and Conservative Management:

For some individuals, the necessity of surgery after an ACL tear might be mitigated through early intervention with physiotherapy. A tailored physiotherapy program focusing on strengthening the muscles around the knee joint, improving balance, and enhancing flexibility can contribute to the stability of the knee. Through consistent and dedicated physiotherapy sessions, some individuals may find that they can manage their symptoms effectively without opting for surgical intervention. We refer to this category of patients as “copers”.


A coper is defined as an individual who showcases excellent dynamic stability in their knee despite having their ACL torn. This means, that under supervision from a physiotherapist, they are able to rehab their knee to full function, normalized sensation of stability and are pain-free despite their torn ACL. They are able to return to sport without ACL reconstruction surgery while having no limitations. 

In comparison, a non-coper is someone who demonstrates consistent dynamic instability in the knee and feels that their knee is shifting in their everyday life despite doing rehabilitation. They might not trust their knee in certain activities as it can feel that the knee is “slipping” or that a re-injury could happen.


With proper rehabilitation through progressive neuromuscular and strength training (NMST), there is a possibility that non-copers can become copers and surgery may not be required. 

Physiotherapy as a Stepping Stone:

Physiotherapy serves as a crucial stepping stone in the decision-making process. In cases where surgery might be deemed necessary, pre-surgical physiotherapy helps prepare the individual both physically and mentally. Strengthening the surrounding muscles and improving overall joint function not only enhances the surgical outcome but also instills a sense of agency and empowerment, addressing some of the psychological burdens associated with the necessity of surgery.

Rehabilitation Post-Surgery:

For those who decide on surgical intervention, the journey does not end with the operating room; it begins with post-surgical rehabilitation, where physiotherapy takes center stage. The rehabilitation process is tailored to the individual’s specific needs, gradually reintroducing movement and exercise while ensuring the knee heals properly. Physiotherapists play a crucial role in guiding patients through this process, providing not only physical support but also addressing the psychological aspects of recovery.

Building Confidence and Reducing Anxiety:

Physiotherapy becomes a key ally in rebuilding confidence and reducing anxiety for individuals contemplating or recovering from ACL surgery. The gradual progression of exercises, monitored by a physiotherapist, helps individuals regain trust in their bodies. As strength and function improve, so does the mental resilience, lessening the fear of reinjury and instilling confidence in the ability to return to normal activities.

Personalized Care and Emotional Support:

One of the strengths of physiotherapy lies in its personalized approach. Physiotherapists work closely with individuals to tailor rehabilitation programs that address not only the physical aspects of recovery but also the emotional challenges associated with an ACL tear. This personalized care fosters a sense of partnership between the individual and the physiotherapist, creating a supportive environment that is essential for navigating the psychological impact of the injury and the decision-making process.

In Conclusion. In the intricate web of emotions surrounding an ACL tear and the consequential decision about the necessity of surgery, physiotherapy emerges as a beacon of hope and an empowering force. Whether it serves as an alternative to surgery through early intervention or as a vital component of post-surgical rehabilitation, physiotherapy addresses not only the physical but also the psychological aspects of recovery. It provides individuals with the tools to reclaim control over their bodies, fostering a sense of confidence, resilience, and well-being in the face of adversity. In the realm of ACL injuries, the necessity of surgery is complemented by the transformative potential of physiotherapy, offering a comprehensive approach to healing.

Depending on your injury, physiotherapists will use a variety of techniques to treat you courtesy by Pursuit Physiotherapy (Read the caption)


This appointment is your opportunity to tell us what hurts and discover whether physiotherapy or chiropractic care is a good fit for you! During this session, you will talk with a physiotherapist or chiropractor on a phone call (or online) and create the right care plan specifically for your pain. There is no obligation on this session is to find out whether physiotherapy or chiropractic care can help you getting back to doing the things you love in life.

Frequently Asked Questions

  • No, surgery depends on factors like tear severity, lifestyle, and capacity to dynamically stabilize your knee during activity. Some opt for non-surgical treatments, while others choose surgery for a full recovery, especially for high level and contact sport.
  • Consult an orthopedic surgeon to evaluate tear extent, age, and activity goals for personalized advice.
  • Consult with a physiotherapist to evaluate the capacity to stabilize the knee using the surrounding musculature
  • Limited self-healing occurs, but complete tear recovery without surgery is possible. 
  • Working with a physiotherapist will help to determine if you may be able to “cope” without ACL surgery. This is dependent on how well you are able to actively stabilize your knee during different forward and lateral movements as well as with hopping and jumping.
  • Possible, but lifestyle adjustments may be needed, especially in activities requiring high levels of impact or in contact sports.
  • Participation in high-impact sports may be challenging, increasing the risk of recurrent injuries.
  • If unable to develop a strong sense of dynamic stability during rehabilitation. Potential consequences include persistent knee instability and an elevated risk of osteoarthritis. Consult with a healthcare professional for informed decisions.

About Dana Tostenson

Dana is a graduate of the University of British Columbia (Masters of Physical Therapy), the University of Alberta (Bachelor of Science in Nutrition), and has completed his Transitional Doctorate in Physical Therapy. He has advanced training in Functional Dry Needling, joint manipulation, chronic pain management, nutrition, as well as vestibular and TMJ disorders.

Outside the clinic you can find Dana on the jiu-jitsu mats, taking in the island’s natural beauty, or tending to his admittedly too many house plants (which have now spilled into the clinic).

Medical Disclaimer:

The information presented in this blog post is for educational purposes and should not be interpreted as medical advice. If you are seeking medical advice, treatment or a diagnosis, consult with a medical professional such as one suggested on this website. The Clinic Accelerator Inc. and the author of this page are not liable for the associated risks of using or acting upon the information contained in this article.

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