When Does a Teen ACL Tear Need Surgery vs. Rehab? A Parent’s Guide
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When your teen is told they have torn their ACL, one of the biggest questions parents ask is: Do they need surgery, or can physical therapy be enough? Matt Brown, MD, orthopedic surgeon and ACL reconstruction expert, answers questions for parents.
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The anterior cruciate ligament (ACL) is one of the major ligaments that stabilizes the knee. It’s especially important for movements like cutting, pivoting, and jumping—common in sports such as soccer, basketball, football, and lacrosse.
When the ACL tears, the knee can feel unstable, painful, and weak. Without the right treatment, your teen may struggle to return to sports and could face long-term risks like arthritis.
Factors that determine treatment
Your teen's age and growth plates
Younger teens with open growth plates: Surgeons may recommend specialized surgical techniques to work around growth plates or involve less of the growth plate than standard surgery.
Older teens who are basically adults: As your teen approaches adulthood, ACL reconstruction surgery is more common.
Activity level and sports performance goals
Competitive athletes: Teens who want to return to cutting and pivoting sports usually need reconstruction surgery for stability.
Less active teens: If your teen doesn’t play high-demand sports there are less invasive ACL repair techniques that can be used. However, there is a known increased lifetime osteoarthritis risk with an ACL tear, so surgical management is recommended for nearly all teens.
Type and severity of the tear
Complete ACL tear: Surgery is usually the gold standard of care, especially if the knee gives out during normal activities.
Partial ACL tear: Some teens can heal and regain strength through structured rehab without surgery.
Related knee injuries
If the ACL tear comes with meniscus damage, surgery is most likely the next step, not only to reconstruct the ACL but also to repair the meniscus. Depending on the ligament, if other ligaments are injured, they might need repair or reconstruction along with the ACL.
For a complete ACL tear, surgery is usually the gold standard of care, especially if the knee gives out during normal activities.
Matt Brown, MD, Orthopedic Surgeon,
Connecticut Children's
When physical therapy alone might be enough
Make sure:
The tear is partial and;
Strength and mobility improve with physical therapy.
Benefits of rehab only: There are no surgical risks, a faster return to everyday activities, and less time away from school. But it's important to maintain contact with your surgeon, as injuries may occasionally not heal or another traumatic incident may completely tear the ACL.
When ACL repair surgery is recommended
Your child will probably need surgery if:
The ACL is completely torn
The knee keeps giving out during walking, running, or sports
Your teen wants to return to high-level athletics
There are additional injuries to the meniscus or cartilage
Benefits of surgery: Greater long-term stability, lower risk of reinjury during sports, and protection against further knee damage.
What to expect after ACL repair surgery
Recovery time: Most teens need 9–12 months before returning to competitive sports.
Rehab is still essential: Physical therapy before and after surgery is critical for regaining strength and motion.
Emotional support matters: Teens may feel frustrated or discouraged—encouragement and patience go a long way. Also continuing to be part of team(s) is important emotionally while going through the rehabilitation process. Even though your child cannot play, they can help the team in other important ways.
No guarantees: The vast majority of athletic patients return to play, but there are always patients who return at a less competitive level or who reinjure themselves within two years of surgery.
The bottom line for parents
Every ACL tear is different. Some teens can do well with physical therapy and changes to activity, while others need surgery and a specific care plan to safely return to sports. The best way to decide is by working with a sports medicine and orthopedic team who understands adolescent athletes.
If your teen has injured their knee, don’t wait. Getting it checked out early ensures the right plan—whether that’s rehab, surgery, or a mix of both—to protect their long-term health and athletic goals.
FAQ
Sometimes, depending how active your teen is. With physical therapy, bracing, and changing up activity level, a partial tear may be managed successfully. But athletes in sports that involve cutting and pivoting will want to work more closely with a care team to prevent instability.
For highly active teens, skipping surgery often means the knee keeps “giving out.” That instability can lead to additional injuries inside the knee, which may limit future sports and increase the chances of arthritis down the road.
On average, most teens need 9–12 months before returning to competitive play. A structured sports physical therapy program is just as important as the surgery itself.
Yes. Pediatric orthopedic surgeons are trained to operate in ways that protect open growth plates. Your surgeon will guide you on the safest timing and technique for your child’s age.
In some cases—especially with partial tears—yes. But for teens who want to return to pivot-heavy sports, surgery usually offers the best long-term stability.
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