Partial ACL rupture. Repair or not?

[Physiobase]

Hi there fellow physios (and others). I have continued to notice that everytime a client with an ACL injury presents to a UK NHS hospital they are told they need surgery for a reconstruction. They are told this with or without MRI.

What I am wondering is whether partial ruptures are simply being cut out so surgeons can practice their reconstruction techniques. Would the client not be better with some reminent ACL attachment that might provide some feedback on joint movement? If so, at what stage would a rupture be considered worthy of reconstruction? Should all be reconstructed? I am not currently aware of any guidelines/protocols that direct doctors on this issue.

Any and all feedback welcome... <img border=0 src="http://www.ezboard.com/images/emoticons/nerd.gif" />

Some guidelines I have seen are:
who should be reconstructed?
fit young active people involved in sports with cutting/pivoting or have physical job,
more sedentary people if c/o giving way,
good prehabilitation 45 min cycling pain free.

Natural history: 44 pts ACL rupure meniscus normal, 30% marked instability and unable to play, 70% return to play average 5.7 wks, 61% who returnied to play had reconstruction within a year

Hope this helps

Injuryupdate.com.au has a good summary:

Partial tears often will progress to complete tears.

Reconstruction is considered when:

- multi-directional demands in chosen sport

- instability in the knee (on examination or functionally)

- long term benefits: willing to risk a degenerative knee?