The question is a very difficult question because there is no exact answer for it. I believe that the best answer resides in knowing all the facts and then making a decision based upon an understanding of this information.

It is generally felt that one does not need an anterior cruciate ligament (ACL) for skating. Most hockey players can compensate for a torn ACL and skate quite effectively. However, an ACL is essential for cutting, pivoting, and twisting sports. While I have seen some college hockey players in the near distant past who chose not to have their ACL’s reconstructed, they did have problems with playing other sports and every couple of months would injure their knee where it would swell up a little bit and put them out of action for a few days. While I have not seen it in a person that cross trains by in-line skating, I believe that in-line skating would be a difficult activity to participate in if one did not have an ACL.

An ACL tear is one of the most common ligament injuries that we see in sports medicine. The ACL is essential to providing stability about the knee for any type of twisting, pivoting or cutting sport. When an athlete is ACL deficient, the knee can actually subluxe, or partially dislocate, with a significant twisting episode. Every time this happens, either the cartilage on the end of the bone or one of the menisci can be torn. About 70% of people who are ACL deficient will develop significant arthritis on their x-rays by 10 years after their injury, and it is felt that a lot of this arthritis develops from these repeated episodes of injury.

To my knowledge, only one study has been published which has actually followed the results of not having an ACL reconstructed during a sports season and monitored what happened to these athletes over the course of the season. The results of this study indicated that it was not good to delay an ACL reconstruction until after the season ended, because over 50% of these athletes were found to have sustained an injury to either their articular cartilage or tore either the medial or lateral meniscus. Since one of the main goals of an ACL reconstruction is to prevent injuries to these two structures, it would be frustrating to sustain an injury of this type when it could have been prevented.

I think that an athlete should make a careful assessment of one’s goals prior to choosing to undergo rehabilitation and returning to ice hockey versus choosing an ACL reconstruction with a near certainty of missing the entire season. In most instances, I would recommend an early ACL reconstruction to make the knee stable and to prevent injury to other important structures.