Long-Term Effects of ACL Tear Without Surgery: My Experience

What Happens if You Don’t Get Surgery for an ACL Tear?

Skipping surgery for an anterior cruciate ligament (ACL) tear may cause your knee to become unstable, increasing your risk of meniscus tears, cartilage damage, and early arthritis. 

But surgery isn’t always necessary. It depends on your lifestyle, how severe the injury is, and how well your knee works after rehab.

I’ve seen both outcomes. Some people return to biking, hiking, and even skiing without surgery. Others notice their knee gives out on stairs or feels shaky with everyday movement. For many of them, surgery eventually becomes the better path.

I understand this from two perspectives. As a board-certified orthopedist, I’ve treated countless ACL injuries. As a patient, I’ve also spent the last 15 years living without an ACL surgery. I know what it feels like to weigh the risks of surgery against the fear of re-injury.

In this article, I’ll share when surgery is truly needed, when it’s not, and what long-term life without an ACL can look like, including my own experience.

What the ACL Does, and Why it Matters

The ACL is a strong band that connects your thigh bone (femur) to your shin bone (tibia). It keeps the tibia from sliding too far forward and helps guide your knee’s rotation.

This control matters most when you twist, pivot, or make quick changes in direction. When the ACL tears, that fine control is lost.

You may still walk or even jog in a straight line. But your knee may suddenly feel unstable with sideways stress or an unexpected move. You might also notice your performance isn’t the same as before the injury.

Can You Avoid Surgery After an ACL Tear?

Yes, in some cases, ACL surgery isn’t necessary. It depends on how severe the tear is, if there’s other knee damage, and what your lifestyle looks like.

ACL injuries are grouped into grades 1, 2, or 3. These grades describe how much the ligament is stretched or torn. Here’s what they mean:

• Grade 1 (mild sprain): The ACL is damaged but still doing its job. It’s keeping your bones together and your knee stable.
• Grade 2 (partial tear): The ligament has stretched too far and is partly torn. You may notice your knee feels a bit loose or unstable.
• Grade 3 (complete tear): The ligament is fully torn or detached. It no longer stabilizes the knee, so the tibia moves more than it should, and creates instability.

It’s natural to think that a grade 3 tear always means surgery. But that’s not always true. You may not need surgery if you:

• Have a partial tear and no instability 
• Have a complete tear but don’t feel unstable during low-intensity activities 
• Do not perform high-intensity sports 
• Do light manual work daily
• Live a sedentary lifestyle 

What you will need, though, is physical therapy. Strengthening the muscles and retraining your joint is important in every case. If your knee feels unstable, you may also need to: 

• Adjust your activities, avoiding sudden stops or quick direction changes
• Use a functional knee brace to improve movement, reduce instability, and lower re-injury risk

At Resilience Orthopedics, I may sometimes recommend platelet-rich plasma (PRP) injections for partial tears. Surgery is always my last option. If your knee feels stable, rehab is working, and you’ve modified risky movements, you may avoid surgery.

That said, I’ll always be honest with you. If surgery becomes the safer choice, I’ll let you know. It may be needed if you injure more than one ligament or your knee shows signs of further damage.

When ACL Surgery Becomes the Right Call

If your knee gives way when you walk or leaves you in pain after sports, your ACL may not be doing its job. Without surgery, this instability and pain may wear down your joint over time, and raise your risk of arthritis later in life.

In cases like this, ACL reconstruction is often the best option. This type of knee surgery restores stability and helps you return to the activities you love. During surgery, your torn ligament is replaced with a healthy graft.

Your surgeon may recommend one of these graft options:

• Patellar tendon autograft: Uses the middle third of your own kneecap tendon with small bone plugs.
• Hamstring tendon autograft: Taken from the inside of your thigh. Often causes less pain at the kneecap after surgery.
• Quadriceps tendon autograft: Taken from the upper thigh. Usually chosen for larger-framed patients or revision surgeries.
• Allograft: Uses donor tissue and is recommended for older, less active patients or those needing multiple ligament repairs.

The graft is placed into your knee with a minimally invasive arthroscopic procedure. It is anchored with small screws or buttons. If you also have a meniscus tear, your surgeon may repair it during the same operation.

Recovery doesn’t end in the operating room. Rehab and aftercare are just as important as surgery itself. You’ll learn how to use your knee safely again. But, returning to cutting or pivoting sports carries a higher risk of re-injury.

In one study, nearly 30 percent of young athletes had a second ACL injury within two years of surgery. About 20 percent injured the opposite knee, and 9 percent re-tore the reconstructed ligament.

What Happens if You Don’t Get Surgery for an ACL Tear?

If you’ve fully torn your ACL and choose not to have surgery, the problems may not show up right away. Your muscles can help for a while, but most people eventually hit a limit.

You might walk fine on flat ground. But when you pivot, jump, or go down stairs quickly, your knee may slip, fold, or give out. That often leaves you with a “loose” or “wobbly” feeling. Over time, that instability may lead to issues such as:

Meniscus Tears

The meniscus cushions your knee during movement. An unstable joint can pinch or tear it, sometimes requiring removal later. One study of over 1,000 patients found meniscus tears in nearly half (44.4 percent) of ACL cases.

Cartilage Damage

Abnormal movement wears down cartilage. This may lead to early arthritis, sometimes in your 30s or 40s. A torn ACL raises the risk of osteoarthritis four times higher than in the uninjured knee, and six times higher than in the general population.

Compensation Injuries

Your stronger leg may take on more work. This may cause pain in your hip, back, or opposite knee, and even raise the risk of another ACL tear.

Chronic Pain and Swelling

What feels like mild discomfort may progress to pain and swelling during daily activities, like walking your dog, getting up from a chair, or climbing stairs.

Risk of Re-Injury

If you have a severe partial ACL tear and you skip surgery, the chance of re-injury is much higher. 

My Experience Living Without an ACL

Fifteen years ago, I was skiing down a slope when I made a sharp turn. I felt a sudden pop, followed by a rush of warmth through my knee. It felt unstable, like something had slipped out of place.

I skied down the slope, but deep down I knew what had happened.

When I reached my husband, who also happens to be an orthopedic surgeon, I told him, “I think I tore my ACL.” He didn’t believe me until we got back to the lodge, and he did a quick exam. 

A follow-up magnetic resonance imaging (MRI) scan confirmed, I had an ACL tear. I chose not to have surgery. 

At that time, I wasn’t involved in any high-impact sports or activities. I practiced Pilates, but nothing that required cutting, pivoting, or jumping. I didn’t want to lose a year to rehab, and I believed I could adapt with the right changes.

So I focused on strength. I built muscle in my legs (quads, hamstrings, and the posterior chain). I also added resistance training to protect my knee and became aware of my movement patterns and avoided risky motions.

For the most part, it worked. 

The only time I second-guessed my decision was during pregnancy. Hormonal changes loosen your ligament ligaments, and at times I felt like my knee might give out. It never did, but it reminded me of the risk I had taken.

Now, 15 years later, I’m still active. I lift, train, and move through daily life without any pain. But living without an ACL means constant awareness. It means steady strength work and respecting my limits. That fits my lifestyle, so it has been the right path for me.

I know this choice isn’t for everyone. Each situation is different, and every body responds in its own way. But approaching the decision with care and intention can help you shape a path that feels like your own, not one you’re forced into.

What to Expect at Resilience Orthopedics

At Resilience Orthopedics, my team and I understand that no two ACL injuries are the same, and neither are the people who experience them. You may need surgery or you may not, but it’ll never be your first or last option. 

My goal is to give you the kind of choice I didn’t have 15 years ago. That’s why we begin with a full evaluation, which includes:

• A detailed physical exam
• Imaging scans
• An open conversation about your goals, activity level, and concerns

When we have the results, I’ll explain your injury step by step. You’ll see how it affects your knee, your alignment, and your long-term health. Then, we’ll go over options like physical therapy, PRP, or surgical reconstruction.

If surgery feels right for you, we’ll create a recovery plan that’s personal and practical. If you prefer a non-surgical path, we’ll create a plan for that too. 

In both cases, the goal is to help you feel strong, steady, and confident in your knee, and on your own terms.

Your ACL, Your Choice. But Choose Informed

Not every ACL tear needs surgery. But doing nothing can lead to long-term problems like meniscus damage and arthritis.

I know this decision is hard. I’ve lived with an ACL tear myself, and I’ve helped many patients through the same journey.

When we talk, I start with your story. What do you love doing? What do you miss doing? What are you most afraid of losing? Your answers guide the treatment path that fits you best.

If you’re in the Bay Area and recently tore your ACL, I can help you understand your injury, recovery options, and what each treatment path includes.

Book a one-on-one consultation today. Let’s find out what recovery could look like for you.