Knee pain: five things you should know about ACL tears

If you had a ACL tear ten years ago, you’d probably be considering surgery. Because the understanding then was that if something is torn, surgery is the only way to fixed it.

In fact, for the longest time, we probably expected ACL tear patients to live in pain unless they surgically repair their ACL.

Do you have an ACL tear? Here are five facts you should know:

You can tear your ACL even without any form of contact

acl tear diagram
Your anterior cruciate ligament contributes to the stability of your knee. It runs diagonally from the back of your knee to the front of your knee, to resist your shin from sliding out.

When we think of ACL injuries, we think of them being torn because of the body was put into awkward, harmful positions. While that is sometimes true, you can tear your ACL even without any form of trauma.

Villa and friends in 2020 published their analysis of 134 injury videos. They identified that only 12% were due to direct contact to the knees and 44% occured from indirect contact (i.e., contact on other parts of the body but not the knee.

44% of the injuries occur without any contact at all!

No difference between surgery and rehabilitation outcomes, even after 20 years

This study isn’t exactly new anymore. It was first published in 2018 and the researchers followed 50 athletes over 20 years. The study found that surgery and rehab had similar outcomes for ACL tears, even after a whopping 20 years!

The study found that the group who opted for surgery had more osteoarthritis than the non-operative group (80% versus 68%).

In short, you may be more likely to get knee degeneration should you decide to go under the knife.

Through laboratory and orthopaedic testing, the researchers were able to find that knees that received ACLs repairs were more stable. However, the difference was non-meaningful as there was no difference in both subjective and objective outcome measures.

The conclusion is that surgery is NOT better than a conservative exercise programme for ACL tears.

Completely torn ACLs can heal themselves!

Yes, you heard that right.

Even if you have torn your anterior cruciate ligament into two, they can still heal without surgery! While it’s not intuitive, it does go to show how robust and adaptive your body is.

Filbay, one of the leading ACL researchers in the world, just published his study on spontaneous healing of ruptured ACLs. Of the 26 cases he managed with rehabilitation alone, over half have a completely healed ACL in two years!

Yes, your ligament can join back itself even if you don’t go under the knife.

You can go back to sports in just nine months

acl knee rupture mri, knee pain

The above MRIs are from a patient with a full thickness ACL rupture (i.e., completely torn into two). The MRI film on the left shows a full-thickness ACL tear while the MRI scan on the right, taken five months later, showed healing of the ligament.

“ACL fibers are now continuous with no retraction and the previously seen torn ends are now well apposed.”

The healing was confirmed by the radiologist. He had no symptoms, and was on track to return to play Australian Rules Football before nine months.

ACL tears can be scary. There’s a lot of pain. Your knee may swell to a size

Thank you Kieran Richardson for sharing your case with us!

Even with surgery success, many patients do not return to pre-injury athletic performance

So far we have covered the physical aspects of what it means to recovery from an ACL injury. At Square One Active Recovery, we take a whole person approach to pain and injury management. With that in mind, we would also have to discuss the non-physical aspects of recovery.

Believe or not, many athletes do not return to pre-injury athlete performance, and also their primary sport. This is true even for patients whose surgeries were considered successful.

So, why is this the case?

There is a lot of psychological aspect to recovery from pain and injury. Very often, we assume the adverse psychological effects associated with the injury will automatically resolve with recovery. This is not true.

Research has identified psychological readiness as one of the factors that could predict recovery outcomes. This is influenced by the patient’s recovery expectations, motivation to get better, fear of reinjury, etc.

Why does it matter to you?

Well, patients with poor psychological readiness are more likely to re-injure their ACL a second time!

What do I do now?

recovery roadmap, chiropractor singapore

As a chiropractor with a strong background working with athletes, ACL injuries is something that we do work with a lot at our practice.

With our evidence-based and whole-person approach to recovery, we don’t only help you heal from your injuries. We take the extra step of finding what what exactly you would like to achieve from us, and partner you in your recovery journey.

Reach out to us via the contact form below for more information on how we can help you help yourself find true freedom from pain!



Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.

Our goal? To make our own services redundant to you.

*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.