Coper vs. Non-Coper – Do You Need Surgery After Your ACL Injury?

ACL

Oct 16

If you’ve recently injured your ACL, you likely have a ton of questions and thoughts running through your head. One of the biggest questions you may be asking yourself is: do I need to get surgery? In this blog post, we will discuss whether or not surgery is the best option for you.

Coper vs. Non-Coper

Before determining whether surgery is the best option, you will need to first determine whether you are classified as a coper or a non-coper. A coper is defined as someone who exhibits good dynamic stability as well as good self-reported and functional outcome measures. A non-coper is defined as someone who exhibits poor dynamic stability as well as poor self-reported and functional outcome measures. Functional outcomes are measured through a battery of tests (i.e. strength and hop tests) and patient reported measures (i.e. questionnaires) all which determine the extent the injury affects function and activities of daily living. Patients who are classified as copers have much higher levels of knee function and quality of life compared to non-copers. However, it’s important to note that classifications are not set in stone, a well designed rehabilitation program can help you go from being a non-coper to a coper.

Non-copers can become copers through a well-designed rehabilitation program.

Additional Factors That Need to Be Considered:

1) Activity Type/Goals: What activities are you trying to get back to? Are you looking to get back to playing a sport that requires a lot of pivoting, change of direction, or rotation? Or are you trying to get back to walking around the block or going on nice, easy hikes? If the latter more accurately describes the activities you want to get back to, then a good criteria based rehabilitation plan may be enough to re-gain the knee stability required for those activities. However, if the former more accurately describes the activities you want to get back to, then a surgical route (in addition to a good criteria based rehabilitation program!) may be the best option as a reconstructed ACL will help to provide the stability required for rotational activities.

2) Age: Injury to the ACL affects the stability of the knee. Instability of the knee has been linked to increased rates in development of osteoarthritis or development of other knee pathologies (i.e. menisci injuries). As a result, it’s often recommended that younger populations opt to get surgery in order to avoid potential complications down the line.

3) Comorbidities: Not all ACL injuries are the same. Some come with additional injuries (menisci tears, additional ligament tears, etc). These comorbidities can affect knee stability and function of the knee, and as a result, can influence your decision on whether surgery is best.

In conclusion, there are a myriad of factors that need to be considered when making the decision whether to get surgery or not. Just know that while surgery may be indicated in many cases, it is NOT the only option.