Do All ACL Tears Require Surgery?
No. Many ACL tears do not require surgery and can be managed non-operatively. Many factors go into the decision-making process to determine if you require ACL surgery. Some patients have ACL tears and no instability symptoms. Others are profoundly symptomatic. That means that their knee feels unstable or loose even with simple stair climbing, turning, or twisting.
We do not know why some people are more symptomatic than others — which is why surgery is not the right answer for everybody. Typically a reconstruction is necessary if you plan to return to competitive activities involving cutting, pivoting, twisting, and rapid side-to-side movements .
There is a difference in how we approach ACL tears in adults and those that occur in children. Please refer to this discussion about the treatment of ACL tears in children.