Dr. Kevin A. Witte, D.O.

It sounds like you have developed arthritis at this point. There are conservative options such as therapy and various types of injections to try first. The injections could be corticosteroids, viscosupplementation, platelet rich plasma, or stem cells. Some of those are covered by insurance and some are not. If you have tried all of those options and you are still in pain, then it may be time to consider knee replacement. Yes, you are still young for a knee replacement and you might need to have a revision in 20 or 30 years. However, it's about quality of life. If you are unable to enjoy life and are choosing to avoid certain activities or events because of your knee pain, then it is appropriate and recommended to have the replacement. Of course the diagnosis and decision would need to be preceded by an exam with an orthopedic surgeon. Also, the rest of your medical history would need to be evaluated first to make sure your healthy enough for surgery.

The choice to repair a torn ACL is dependent on several factors. First, most ACLs are reconstructed and not repaired, however, there is a new trend and increased success lately with repair of the partially torn ACL or with repair in the very young population that may still have growth plates still open. As for most patients, it is recommended to reconstruct the ACL to prevent the development of future meniscal injuries and arthritis. The ACL helps provide stability to the knee in a few directions and thus helps protect the meniscus and cartilage and helps patients get back to activities. In my practice, one of the few reasons to choose not to reconstruct or repair an ACL would be if a patient already has significant osteoarthritis. If the patient already has significant osteoarthritis and is a candidate for a total knee replacement, then it would be acceptable to not fix the ACL and just do a knee replacement when the pain or instability is sufficient enough to warrant it. This incident will most likely be in the older population. Some will argue that with physical therapy and bracing you can avoid ACL surgery and compensate for a torn ACL. I will argue that very few patients who choose this route actually return to their previously level of activity or their previous knee satisfaction. In general, my recommendation is to reconstruct or repair ACLs unless the patient is not healthy enough to do so, or already has too advanced degree of arthritis.