23M, complete ACL tear + partial MCL/Stieda fragment — surgeon advises AGAINST reconstruction citing arthritis research, but I found conflicting studies. Looking for advice/perspectives.
Greetings all,
About a month ago I (23M, Belgium) fell in a really weird way. My friend saw me fall and told me on the spot he was pretty sure my ACL was torn. Fast forward to my MRI a few weeks later, and he was right.
MRI findings:
- ACL completely torn
- MCL partly torn, possibly with a small bone fragment at the medial femoral condyle (a "Stieda fragment")
Activity level: Currently I only do fitness (3–5x/week) and run 5–10km (1x/week) — no soccer, football, or other pivoting/contact sports right now. I did do contact sports for years in the past (kickboxing, muay thai, BJJ), but stopped because of the relatively high injury risk. Even after stopping, though, I liked knowing I had the "freedom" to go back to it if I ever felt like it.
Surgeon's assessment:
A few days ago I had my consultation. He reviewed the MRI and asked whether I currently play soccer, football, or any other pivoting/contact sport. Based on my answer, he advised against ACL reconstruction for now — his plan is that if I ever feel my knee "give way" during daily life, fitness, or running, I call him and we do the surgery then.
He followed up with two things that surprised me:
- Recent research shows ACL surgery is associated with an increased risk of arthritis, citing Barenius et al. (2014) and Ferrero et al. (2023) — see sources below.
- Some surgeons' compensation is tied to the number of surgeries they perform, which (in his view) can bias some colleagues toward operating even when it isn't necessarily in the patient's best interest.
I thanked him for the honesty. He will still perform an arthroscopy to "clean up" the knee regardless.
Where that leaves me:
I left a bit confused, honestly, I always assumed ACL reconstruction was the "correct" default in this situation. When I got home I looked into the studies he mentioned, but I also found research pointing the other way: the KANON trial and Tsoukas et al. (2016), both of which found no significant difference in long-term arthritis rates between surgical and non-surgical management (sources below).
So now I'm torn (no pun intended). I obviously want to avoid arthritis down the line, but I'm also worried that one more bad twist could cause further damage — e.g., to the meniscus — which would raise my arthritis risk anyway, surgery or not.
Current physical status:
- Pain-free walking around the house
- Mild pain when shopping/walking around the city for a while with my girlfriend, or standing up after sitting for a long time
- Knee feels stable walking and on stairs
- ROM: ~90–97% extension, ~85% flexion
One more wrinkle:
I start my first real job in about a month — a corporate role at a Big 4 firm — which is genuinely bad timing for ACL surgery, since the first few weeks are important for onboarding and integrating with the team.
What I'm hoping to get from this sub:
Has anyone been in a similar spot — borderline knee stability, no current pivoting/contact sports, and conflicting research pulling you in different directions? How did you end up deciding between surgery now vs. a wait-and-see approach? Any regrets either way, looking back?
Thanks in advance for any input.
Sources referenced above:
- Barenius, B., Ponzer, S., Shalabi, A., Bujak, R., Norlén, L., & Eriksson, K. (2014). Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: A 14-year follow-up study of a randomized controlled trial. The American Journal of Sports Medicine, 42(5), 1049–1057. https://doi.org/10.1177/0363546514526139
- Ferrero, S., Louvois, M., Barnetche, T., Breuil, V., & Roux, C. (2023). Impact of anterior cruciate ligament surgery on the development of knee osteoarthritis: A systematic literature review and meta-analysis comparing non-surgical and surgical treatments. Osteoarthritis and Cartilage Open, 5(3), 100366. https://doi.org/10.1016/j.ocarto.2023.100366
- Frobell, R. B., Roos, E. M., Roos, H. P., Ranstam, J., & Lohmander, L. S. (2010). A randomized trial of treatment for acute anterior cruciate ligament tears. New England Journal of Medicine, 363(4), 331–342. https://doi.org/10.1056/NEJMoa0907797 (KANON trial, original 2-year results)
- Frobell, R. B., Roos, H. P., Roos, E. M., Ranstam, J., & Lohmander, L. S. (2013). Treatment for acute anterior cruciate ligament tear: Five year outcome of randomised trial. BMJ, 346, f232. https://doi.org/10.1136/bmj.f232 (KANON trial, 5-year follow-up)
- Tsoukas, D., Fotopoulos, V., Basdekis, G., & Makridis, K. G. (2016). No difference in osteoarthritis after surgical and non-surgical treatment of ACL-injured knees after 10 years. Knee Surgery, Sports Traumatology, Arthroscopy, 24(9), 2953–2959. https://doi.org/10.1007/s00167-015-3593-9