Partial ACL tear: does it need surgery?

With a partial ACL tear, patients get the most confused by the word "partial". First, let's understand. Your report says "partial". That doesn't mean 50-50.

A partial tear can be anywhere from 10% to 95%. So a 10% tear is also called partial, and a 90% tear is also partial. So how can every partial tear have the same treatment? In 2019, ACL experts from all over the world gathered in Pittsburgh, America, at the Panther Symposium. One of their opinions: if the knee still feels unstable after physio, or your daily life involves a lot of jumping or turning, then surgery is the better route.

So, the direct answer: three things decide what the treatment will be. First, your job, your lifestyle, and if you are a player, your sport. Second, the condition of your knee. And third, whether physio and injection made a difference or not. Let's understand them one by one.

First, let's look at your lifestyle. A desk job, walking only in a straight line, a relaxed lifestyle: in all of these, there is less stress on the knee. But if your work is physically heavy, like police, army, factory worker, construction worker, long driving, riding a bike, standing for long periods, doing gym, yoga or exercise regularly, or you play cricket, football, kabaddi, badminton, where you have to turn, twist, jump, and so the knee takes more stress, and the knee needs full strength.

The second thing: what condition your knee is in, not the percentage in the report, but the actual condition of the knee. While walking, does the knee feel stable or not? Does it feel like the knee is giving way? If the knee lets you down on stairs or when turning, then the partial tear is behaving like a full tear.

The third thing: 6 weeks after the injury, you did physio, you had the injection, and still saw no difference. These days, in many places the claim is made: 90% don't need surgery, fit with one injection. The truth is this: physio strengthens the muscles, the injection reduces pain, but neither physio nor an injection joins a torn ACL. The pain has reduced, but the knee has not been fixed. And a partial tear does not stay as it is.

Dr Frank Noyes from America followed 32 patients, whose partial tear was confirmed on arthroscopy, for 7 years. Of those whose ACL was one-fourth torn, a full tear happened in few, of those whose ACL was half torn, 50% went on to tear completely, and of those whose ACL was 3/4 torn, 86% tore completely. And this is not old news. In 2019, Dr Fayard's team in France followed 41 active patients under 30 years of age without surgery. In about 3.5 years, the ACL tore completely in 4 out of every 10, and in 50% of those, the meniscus had also torn. In patients with a partial ACL tear, whenever the knee slips, the meniscus and cartilage also wear away.

The good news: partial tear surgery is not like surgery for a fully torn ACL. Pioneer surgeons like Dr Bertrand Sonnery-Cottet of France have shown: don't remove the remaining ACL, save it and support it. In 2025, Dr Chunrong Chen's team from China, combining many studies, found that in everyone whose partial ACL was saved, the knee was more stable, function was better and there were no extra complications, because the remaining ACL has nerves and blood supply, which help to keep the knee stable.

In this, there is one option, Jewel ACL, a synthetic ligament that is made in the UK. It is fitted along with the remaining ACL, no graft is taken from your body, and it gives strength from day 1. Yes, it costs more and it is not for every case. Who gets Jewel ACL, who needs only support, and who needs a new ligament, is decided by examining the knee.

This is SAFE ACL, the latest approach, in which surgery is planned by looking at your knee. In recovery, we follow international standards and protocols, the same ones that the world's pioneer ACL surgeons follow. From day 1, straightening the knee fully; in week 1, walking without support; in week 2, walking normally; in 3-4 weeks, office, daily activities and driving; in 3 months, running and gym; in 4-7 months, back to playing sports. And if Jewel ACL is used, return to running, gym and sport in 2-3 months, but only when the knee muscle strength is equal to the other leg.

And after surgery, what next? Dr Sergi Sastre's team in Barcelona, Spain, followed patients who had partial ACL surgery for 6 years: the knee stayed stable, most returned to sport, and re-injury was very rare. In a partial ACL tear, not everyone needs surgery, but for those whose job or sport puts stress on the knee, whose knee feels unstable, and who saw no difference even after physio and injection, the right surgery at the right time is essential.

If your MRI shows a partial tear and your knee is still not right, send your report on WhatsApp, and we will look and tell you what your knee needs. The number is on the screen and in the description. Thank you.