Tenho uma rotura do LCA — tenho de ser operado?

Não necessariamente. A decisão depende do nível de actividade, idade, presença de instabilidade e lesões associadas. Patients sedentários com joelho estável podem ser tratados de forma conservadora. Patients activos com instabilidade repetida têm indicação cirúrgica.

Quanto tempo dura a recuperação da cirurgia ao LCA?

A maioria dos doentes regressa ao desporto entre 9 e 12 meses após a cirurgia, quando cumprem critérios de força e funcionais validados. O retorno precoce antes dos 9 meses está associado a maior risco de re-rotura.

ACL Tear — Surgery or Conservative Treatment?

What is the ACL

The Ligament that Stabilises the Knee

The anterior cruciate ligament (ACL) is one of the most important structures for knee stability. It controls the anterior translation of the tibia relative to the femur and resists internal rotation — movements essential to changes of direction, braking and jumping.

An ACL tear typically occurs through sudden deceleration, pivoting or contact with another player. Patients often hear or feel a "pop", followed by acute pain and rapid swelling of the knee.

Each episode of instability — the feeling of the knee "giving way" — can cause further injury to the menisci and cartilage. For this reason, the treatment decision should not be postponed indefinitely.

An ACL tear rarely heals on its own. Without appropriate treatment, an unstable knee accumulates secondary injuries that worsen the long-term prognosis.

Surgery or Conservative Treatment?

This is the central question in an ACL tear. The answer is not universal — it depends on individual factors that the specialist will assess in consultation.

✓ Conservative Treatment

Low level of physical activity (sedentary)
Stable knee with no episodes of instability
No associated meniscal or ligament injuries
Older age with low functional demands
Patient declines the surgical / anaesthetic risk
Acute phase with severe AMI — stabilisation may be needed first

→ Surgical Reconstruction

Active patient with recurrent instability
Athlete in pivoting sports (football, basketball, skiing)
Associated meniscal or chondral injuries to treat
Failure of conservative treatment
Young patient with high expectations of returning to sport
Combined multi-ligament injury

Clinical note: Current research (2024 systematic review) shows that conservative treatment can be appropriate for selected patients — but the risk of secondary meniscal and chondral injury in unstable knees is real and cumulative. The decision requires an individualised assessment.

Surgical Technique

Graft Types for ACL Reconstruction

ACL reconstruction uses a tendon graft to replace the ligament. The choice of graft is individualised and influences the long-term outcome.

Hamstrings (Semitendinosus)

The most commonly used graft. Low harvest morbidity, good mechanical strength. Can be combined with gracilis for greater volume.

Most used

Patellar Tendon (BTB)

Bone-tendon-bone graft. Faster bone integration — favoured in elite sport and high-demand primary reconstructions.

Elite sport

⬆

Quadriceps Tendon

Increasingly used. Large graft volume, acceptable morbidity, good integration. A valid option especially in older patients.

Growing trend

Bank Graft (Allograft)

Donor tissue. No harvest morbidity — reserved for revisions or specific situations with a shortage of autologous graft.

Revisions / complex cases

Protocol of Excellence

SANTI Protocol — The Lyon Approach

The SANTI protocol (developed by Prof. Bertrand Sonnery-Cottet at the Centre Orthopédique Santy, Lyon) integrates the assessment and treatment of arthrogenic muscle inhibition (AMI) into the ACL surgical protocol — an outcome differentiator that few centres apply systematically.

Pre-operative AMI Assessment

Grading of quadriceps inhibition before surgery. In selected cases, surgery is postponed until the AMI resolves.

Surgery + Lateral Ligamentoplasty

ACL reconstruction combined, when indicated, with extra-articular tenodesis (Lemaire technique or Anterolateral, refined by Sonnery-Cottet) for rotational control.

Post-op Neuromotor Rehabilitation

Quadriceps reactivation protocol and treatment of residual AMI from the first post-operative day.

Learn more about AMI (quadriceps inhibition) →

Rehabilitation

Milestone by Milestone — Return to Sport

Early return before 9 months is associated with a higher risk of re-tear. Strength and functional criteria matter more than time alone.

Dia 1

Walking with crutches. Quadriceps activation.

2–4 sem

Walking without support. Extension and flexion to 90°.

6 sem

Stationary bike. Progressive strengthening.

3–4 meses

Straight-line running. Advanced proprioception.

6 meses

Changes of direction. Isokinetic strength testing.

9–12 meses

Return to contact sport after validated criteria.

Questions about the ACL

Not necessarily. Imaging does not replace clinical assessment. Patients with stable knees and low sporting demands can be treated conservatively with success. The decision depends on activity level, the presence of instability and associated injuries.

Optimal timing depends on the presence of arthrogenic muscle inhibition (AMI) and joint effusion. Operating with severe AMI or a very inflamed knee increases the risk of arthrofibrosis. In many cases it is preferable to wait 3–6 weeks after the acute injury to regain range of motion and muscle activation before surgery.

There is no universally superior graft. The patellar tendon (BTB) has faster bone integration and is often preferred in elite sport. The hamstrings have lower harvest morbidity. The quadriceps tendon is gaining popularity. The choice should be individualised with your surgeon.

Yes — the great majority of patients return to their pre-injury level of sport. Return to contact football is typically between 9 and 12 months, conditional on meeting strength criteria (>90% quadriceps symmetry) and validated functional tests. Early return before 9 months significantly increases the risk of re-tear.

Extra-articular tenodesis (the Lemaire technique or Anterolateral, refined by Sonnery-Cottet) is a procedure added to ACL reconstruction to control excessive internal rotation of the knee. Today its indications cover a wide range of clinical cases — not just a few selected patients: they lower the ACL re-rupture rate and protect repaired menisci, and have become one of the main "rediscoveries" in knee surgery in recent years. It is indicated in patients with hyperlaxity, high-rotation sports or a history of significant instability. It is not applied in every case.

ACL Tear — Do I Need Surgery?