Professor Julian Feller on LARS and how psychological barriers impact ACL recovery.

There is a common assumption that if you tear the Anterior Cruciate Ligament (ACL) you must have surgery, however, according to Professor Julian Feller, a Melbourne based Orthopaedic Surgeon there is a group of patients that will cope without surgery.
 Prof. Feller believes there are patients for whom a trial of non-operative management can determine if they can get by or need surgery.
The number of factors determine if an operation is required, however, the initial main ones are how the knee feels and what the future activity, goals and needs of the athlete are.
Giving the athlete time to make this decision is also important. A lack of urgency on the part of the consultancy can in some instances help the patient get their head around the procedure.
With professional players, especially in Feller’s experience Australian Rules Football (AFL), there is a lot of support leading up to the moment of surgery however when they wake up the full impact of what happens to their season really hits them.
That realisation leads to, in some instance, the athlete having less tolerance for pain and the rehabilitation process. Some literally “fall in a heap” as they come to terms with the post-operative process.
There are two trains of thought here. One is that the athlete’s tissues are firmer, harder and tighter, maybe they have harder bone however a lot of it is the psychological impact of the injury that influences their ability to cope with pain and swelling.
The post-op support structure for the player is not the same before they go under the surgeon’s knife, and this makes it difficult for the player to accept.
While the surgery itself is unlikely to undergo a major transformation and will remain a very predictable procedure, the pre and post-operative process will change, something that will help with individual athlete’s needs.
Recovering and the decreases in re-injury are just as much down to the rehabilitation as it is the surgery. Going forward it would appear that graft targeting on an individual basis will form a key part of the process while there is still research ongoing to determine if extra particular procedures will have a role.

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