Everyone saw her go up for the lay-up, but as soon as she came down there was a crowd around her. She screamed in pain as coaches, teammates, and athletic trainers ran to her. Something was clearly wrong. She was briskly rushed off to the side with her arms around two athletic trainers, crying in pain. The opposing coach, puzzled by the fact she went up for a wide-open lay-up with no one around her, slowly walked to their side of the bench. As the athletic trainers gently sat her down at the end of the bench, teammates overheard the other coach explain his player was in fact playing competitively with a torn ACL. The opposing coach's face went white; this was not the explanation he was anticipating in the slightest. He then went to explain that she had torn her ACL two years ago and simply wears a brace while playing competitively. Her coach also said that she's had many falls like this before, but never have been bad to the point where she couldn't get up. This is just one example of why surgery is a more beneficial and efficient option. Surgery for a torn ACL is not only crucial if one wants to stay healthy for playing sports, but can benefit that person more in the long run, with less pain and relapses. 

ACL's are arguably the most important ligament in the knee. An anterior cruciate ligament, known as the ACL is a "ligament in the knee that crosses from the underside of the femur (the thigh bone) to the top of the tibia (the bigger bone in the lower leg" (MedicineNet). It can become torn from a simple cut, pivot, and change in position. One doesn't have to be playing sports or make contact to have this injury occur. The ACL's function is important for your knee as a whole, but specifically, "the ACL keeps the shinbone in place and prevents it from moving too far forward and away from the knee and thighbone. It also provides stability when rotating the shinbone"(KidsHealth). If the ACL is torn, everything else within the knee is affected considerably. This is a very common injury that is devastating to athletes and non-athletes alike because surgery and recovery is demanding and intense (MedicineNet). 

Around 100,000 to 200,000 people tear their ACL's every year, and that's just counting the United States (ACL tears). That means there are 100,000 to 200,000+ people feeling hopeless and scared when this devastating injury occurs. On a positive note, this is clearly a common injury, and surgery is an option that will greatly improve the patients well being for many reasons.  People recover from ACL injuries far easier when they receiver surgery. Surgery should not be considered as an option, it should be the only option. 

There are a lot of things one must prepare for once their ACL is torn. They need to stop participating in whatever athletic team they are currently on for about a year or so. If they are not involved in an athletic team, they need to adjust to how they do normal tasks such as walking, running, and climbing up and down the stairs. As soon as someone tears their ACL, they must know they have an extensive road of recovery ahead. They need to get X-rays, chose the doctor that is right for them, schedule surgery, schedule their future rehabilitation sessions, and find a convenient physical therapy place that will accommodate them accordingly. Even if the patients decided to not undergo surgery, they would still have to schedule physical therapy. 

Many people assume that by not getting surgery, they can avoid the heavy time commitment rehabilitation takes up, however, they are completely wrong. No matter what they decide, it will take about the same time as someone who decided to get surgery. Nonetheless, the patient who did not partake in surgery will have a lifetime of further complications, while the patient who got surgery is ready to take on anything confidently. Even a person does not participate in sports, "recent studies show that people who don't have their damaged ACL reconstructed could be at greater risk of meniscus tears, early arthritis and cartilage damage, due to the reduced support of the joint system as a result of the ligament damage (MobileHealth)." This is evidently not something that happens overnight, but the long-term effects eventually hurt the knee more than it can help with no surgery. As technology keeps transforming leaps and bounds everyday, surgery is becoming less invasive and disruptive. Along with technology, surgeons are gaining more experience and becoming smarter about the dynamics of surgery (MobileHealth). The long-term benefits of surgery are becoming more prevalent and efficient. 

The actual surgery requires the patient to choose one of three grafts that will be in place as their new ACL: patellar tendon, hamstring, or cadaver. The decision between patellar tendon and hamstring graft is up to the patient because these grafts are very similar and have much of the same pain levels. The cadaver graft, also know as allograft tissue, is taken from a deceased donor. This graft is usually only needed when a patient has to get surgery on the same knee a second or third time (Webmd). Surgery is performed by an orthopedic surgeon that makes small incisions in the knee and inserts instruments through these incisions, which is called arthroscopic surgery (Webmd). Yes, surgery is intense and not a light hearted, easy task to undergo; but the positive results of surgery will stay with the patient for the rest of his or her life. 

Like everything, there are two sides to ever story. Those who decide not to get surgery argue that they could walk and run perfectly normal and don't need to undergo surgery. Unfortunately, the only people who should fall in the category of not being eligible for surgery should be the patients who partially tear their ACL, and young children whose growth plates are still growing (ACLinjury). So, yes, they are the ones who could manage to do things without having to undergo surgery, and even they still have to do therapy to an extent. Many people who play sports and don't want to get surgery would also like to debate the fact that they can tape up/brace their knee to a point where it is tight and locked in place enough to compete like normal. This scares many doctors because this has never, nor ever will be recommended for athletes. This solution is short term because eventually the knee that is never repaired will fall susceptible to the daily wear and tear, and it is not strong enough to withhold much. Other ligaments within the knee important structures will shift fall out of place too easily. Remember, the ACL is "rubber band" that holds the knee together (MobileHealth). If it is never fixed properly, then other ligaments that make up the knee will compensate for one's body and try to fill in the gap. This can be dangerous and cause further injury to either knee (ACLinjury). The repercussions of not getting surgery are overall dangerous and harmful to your body. 

Another counter argument is once a person reaches a certain age, there is no need or sense to undergo surgery. This would be understandable if the patient was around 70-90 years of age. Despite that, even if one is on the older side and not necessarily known as 'active,' surgery should still be something they undergo. Every patient is different, and no one knows how he or she will react; "Anyone, of any age, no matter how much physical activity they do, who experience repeated episodes of their knee giving out and who have not responded to non-surgical treatment for their damaged ACL would benefit greatly from ACL reconstruction surgery" (MobileHealth). Many people think because they don't play a sport their ACL isn't needed, this is wrong. They shouldn't be worried about if they participate in sport's or not, they should be focused on that fact that it will be hard to walk, run, or sit if surgery is not preformed. 

A patient doesn't even need to be a top athlete to have this surgery performed. The key to surgery is that it allows people to do everything and more of what they did before they tore their ACL. If they played casually and recreationally for exercise, they don't need to quit indefinitely, simply take a year off to recover and come back with a strong knee. People shouldn't let this accidently injury taint their life for them in a bad way. It is easy to see it that way and have self-pity because many critiques' argue that people never come back half as strong from ACL injuries. The amount of athletes that have proved this theory wrong is impeccable. This injury has irrefutably effected many athletes, and they never gave up and came back even stronger than before. There is some sense that is easy to see when thinking about the patients who decide to not receive surgery. If you aren't intensely active and don't get pains from your torn ACL, then there is not much incentive to get surgery and that is understood. However, in general, surgery should be an important part of repairing one's ACL and making that patient 100% and participating again. 

Physical therapy is an integral process of the torn ACL and should be where all the patient's focus goes, no matter if they undergo surgery or not. Therapy includes a lot of hard work and determination to become healthy:"In the first 4 weeks after surgery, your physical therapist will help you increase your ability to put weight on your knee, using a combination of weight-bearing and non-weight-bearing exercises. The exercises will focus on your quadriceps and hamstrings (thigh muscles) and might be limited to a specific range of motion to protect the new ACL" (MoveForward). This rehabilitation process lasts for around 5-6 months and allows one to get better and improve each day by challenging them and pushing their knee to new levels. 

Rehabilitation can be a tricky process for someone who never decided to receive surgery because there can be less motivation involved. If one never received surgery and never suffered during the first week after surgery (where it was almost unbearable to walk just two feet) then how can they truly be inspired and enthusiastic about changing their situation? They are in a completely different mental state and might never be able to understand just how important rehabilitation is for their knee. On the contrary, the rehabilitation process will be taken seriously if the patient undergoes painful surgery and is motivated and egger to get themselves out of the miserable state they are in. If the patient never experiences intense pain and takes physical therapy for granted then there is no hope for them. Physical therapy is the place where the patient gets the privilege of recreating and making their torn knee even stronger. Without surgery, they might be in and out of therapy for years because they can never quite do the exercises as many times as needed. Meanwhile, the patient who got surgery is working as hard as they possibly can every day to see simple improvement muscle gain. Everything is a domino effect with this surgery process. Every part is just as important and meaningful as the prior. People who don't get surgery will never be able to experience the true reward of graduating physical therapy and moving on to everything they loved in life. There is less of a goal for them because the injury is less serious to them. Physical therapy is supposed to be a hardworking and inspiring place that pushes the people who want to get better, and the results don't lie. 

No one knows what happened to that girl after her big fall, however, I hope she decided to undergo surgery to finally stop the forever brace wearing and living in daily fear that she could tear other ligaments in her knee and mess her up even more in the future. ACL surgery is a intense, but it is worth it in every way. No one wants to be like the girl described earlier who at every fall is uncertain if she has torn more ligaments or if she's ok. The fear of the unknown of not getting surgery should scare people. Day to day interactions and simple tasks would be done with precaution and apprehension if surgery were not performed for many people, and not just athletes. Rehabilitation would not be taken seriously and there would be a lack in motivation for the patients who had not gotten surgery. The long-term effects of getting surgery undoubtedly outweigh the negatives for this injury. Someone who never received surgery would wear down their knee day to day is because they never know what will trigger their knee to buckle, and then three more ligaments that aren't supported by their torn ACL tear, and they are even more injured than before. Yes, there are short-term solutions for not getting surgery like wearing a brace and not exercising, but these solutions should not be anyone's first option. Surgery is a one time procedure that can improve a person's life and once it is done, their knee and their life is back to normal. 

