Special Situations: Delayed Care

July 2, 2025

Special Situations: Delayed Care

What Do You Do When ACL Treatment Isn’t Immediate

When an anterior cruciate ligament (ACL) injury occurs, early diagnosis and treatment can often help improve outcomes. But sometimes, care is delayed; either because there are more urgent injuries that must be addressed first, financial or insurance reasons, or due to limited access to medical resources. Whether you’re waiting for surgery, physical therapy, or even an initial diagnosis, it’s important to understand how to protect your knee and prepare for eventual treatment.

In a lot of cases. you or your surgeon may want you to delay somewhat in order to get ready for surgery. “Prehab” can get you stronger going into surgery which can give you a better head start on recovery than you’d otherwise have. You can also see how prehab goes and this can help you decide on whether the surgical route is truly indicated. As well, you can research your options in terms of graft types and prepare the rest of your life issues for your surgery recovery time.

Delay Due to Concomitant Injury

ACL injuries are sometimes accompanied by other musculoskeletal trauma, such as fractures, dislocations, or meniscal tears, that take clinical precedence. For example:

Fractures: A tibial plateau fracture may need to heal before ACL reconstruction is attempted.
Multi-ligament Injuries: Severe trauma may involve the PCL, MCL, or LCL, requiring complex staged surgical planning.
Swelling and Inflammation: In cases of acute joint effusion or hemarthrosis, immediate surgery might increase risks. Surgeons may recommend a delay until swelling subsides and knee mobility improves. (Some surgeons have said they need a “quiet” knee or settled down knee before operating.)

What You Can Do in the Meantime:

Begin prehabilitation as advised; a guided exercise program to maintain strength and range of motion in the surrounding musculature. You’ll likely want to keep your quads strong. If you can do official prehab, great. If not perhaps use of an app or minimally, your own consistent exercises.
Protect the joint: Use bracing or crutches if instability is significant.
Avoid pivoting, running, or uneven terrain to reduce risk of worsening the injury. You’ll have to pay more attention to terrain as well. Uneven terrain isn’t just an obviously uneven field. Sandy beaches, soft bottoms of lakes, and similar areas present uneven and shifting surfaces that could put an unstable knee more at risk of buckling than solid ground, floors or pavement. People may tend to not consider such things as they never had to before.
Follow pain and inflammation control measures: ice, elevation, and possibly acetaminophen or other pain relievers if medically appropriate.

Delay Due to Access to Care

Living in a rural area, facing insurance hurdles, or being in a healthcare system with long surgical wait times can delay ACL evaluation or treatment. Even in well-resourced systems, patients may face months of waiting for specialist consultation or operating room availability.

Key Considerations for Patients in These Situations:

Get a Diagnosis: If possible, obtain an MRI or at least an orthopedic assessment early, even if definitive care will be delayed.
Start Basic Rehab: Even without surgery, strengthening exercises for the quadriceps, hamstrings, and glutes are beneficial. Physical therapy (or self-guided regimens) can help limit deterioration.
Use Supportive Gear: A functional brace may provide some stability during daily activity.
Track Symptoms: Keep a journal of instability episodes, swelling, and functional limitations; this can help guide future care decisions.

Psychological and Lifestyle Impacts

Being in a holding pattern can be emotionally difficult. Activity limitations may affect work, sports, or family life. If possible, seek mental health support or community resources to help cope. Stay engaged in what movement and routines you can safely do; whether it’s swimming, upper body workouts, or guided mindfulness practices.

Risks and Considerations for Delay

While there may not always be a choice, it’s still good to understand the issues. For some patients, delay or even having surgery at all might not matter. Elderly or sedentary patients may choose to opt out of surgery altogether. But for those for whom it’s indicated, here are some things to consider.

Curtailed Activity: If you, (the patient), participate in sports, it’s likely a bad idea to participate in any sports that have extreme cutting or pivoting movements. Besides risking additional damage to the knee itself, it’s possible other injuries are more likely if a knee buckles, causing a fall that otherwise might not have happened.

Additional Damage Over time: It’s possible that compensatory movements risk injury to other body parts, (such as the other knee), or that cartilage, meniscus or other damage could become worse in the injured knee. This is a frequent topic for debate among those discussing surgical vs. non-surgical routes, and studies vary. Part of the challenge in assessing truth in these areas is that it can be challenging to determine to exactly what extent an injury may be. While we have MRIs and other means to test laxity, until a surgeon actually looks at the site, it’s impossible to truly know for sure what’s going on.

It’s believed that delay can, (with general activity), cause damage to the meniscus as well; specifically, medial meniscal tears. It should also be noted that MRIs are imperfect. They might not show certain types of meniscal tears. So a surgeon might not find this out until actually doing an arthroscopic exam or during an ACL surgery.

When Surgery Is Finally Scheduled

Delayed reconstruction isn’t necessarily a disadvantage. Some research suggests that patients who enter surgery with stronger muscles and full range of motion have better outcomes. Use the time to prepare physically and mentally. But also be aware of the risks of further damage during the waiting period, especially if the knee remains unstable.