Will your ACL heal on its own? This is a question that’s been highly debated for decades. In general, the structures in the knee joint have very poor blood supply, and the tendency for healing is not often seen. There are, of course, exceptions to that rule, such as the immature skeleton (young patient).
In general, ACL full thickness tears do not heal. In the active and young patient, they most often come to surgery, which would involve some form of ACL reconstruction, where a graft is taken from another part of the body, commonly the hamstring or patellar tendon, and inserted into the original ACL site.
There are various groups in Melbourne and other cities suggesting that there is some reparative process possible with bracing. My experience as a knee surgeon, is that having seeing 6 patients going through these protocols, that any healing is seen on MRI scanning only and not seen clinically, and that there is some scar tissue that bridges the tear, but the ACL often “heals” elongated. This results in the knee subluxing and pivoting. And out of the six patients I’ve seen that have failed a bracing type technique for attempted ACL healing, four of them presented with a new meniscal tear, and these are a tragedy in the young patient because they could have been avoided.
I would counsel patients who have been promised recovery with conservative measures that this is basically unproven. And the only very short term studies that have been published have been done by the practitioners themselves, and there’s no long term follow-up. Another issue, of course, is that often is the case that the patient is not told that if they go down the path of conservative measures and go back to sports, that there is a chance of the meniscus tearing if the knee subluxes. This is a big concern.
I haven’t come across any patients so far who have had a great result with conservative measures and returned to sports. But that doesn’t mean that all patients need surgery. There have been patients in my practice that either have no need for the ACL, such as the older patient, or patients who will be foregoing the sports that have caused the ACL in the first place to tear. But these should be intimately discussed with your experienced knee orthopaedic surgeon.