Q: I might need an ACL repair job. The tipping point in deciding is whether or not I want to continue playing sports hard. I'm just a recreational athlete, so it's not like I'm losing millions of dollars by not playing. Can you offer me any information that might help me?

A: There might be several things you will want to consider in making this decision. Does your surgeon think conservative care with a rehab program is enough to get you by if you aren't playing hard?

Less active adults (usually older) may be able to avoid surgery if 1) the anterior cruciate ligament isn't fully ruptured, 2) there are no other areas of damage (e.g., meniscal tears, holes in the cartilage, other ligaments torn), and 3) you are committed to complete the necessary rehab program and keep up with a maintenance program for life.

Many studies have shown that athletes can return to sports activities at the same level as before the injury. But many times, the ACL injury and reconstructive surgery does tend to mark a dividing point in how active patients are. There is a fair number of athletes who don't return to full participation in their previous sport. Sometimes, they switch to a different sport instead.

Another thing to consider is the importance of staying physically active throughout the adult years. There's plenty of research showing the importance of exercise to stay healthy and prevent problems like diabetes, heart disease, obesity, and cancer (to name just a few). Will you be able to do that if your knee is unstable, painful, or weak?

It might be helpful to you (and your surgeon) if you came up with a list of goals you have for the next 10 to 20 years. What activities do you want to participate in? At what level would you like to join in the fun?

Be specific in terms of how often you would practice or play. Consider how competitive you are -- you may think a leisurely pick-up game of basketball or soccer will be fine but when you are on the court, do you suddenly become highly competitive? An unrepaired ACL tear may not hold up under those circumstances.

Again, these are all things you should discuss with your surgeon. He or she will be the best one to advise you based on clinical testing performed on the knee (motion, laxity, str

Reference: Britt Elin Øiestad, PT, MSc, et al. Knee Function and Prevalence of Knee Osteoarthritis After Anterior Cruciate Ligament Reconstruction. In The American Journal of Sports Medicine. November 2010. Vol. 38. No. 11. Pp. 2201-2210.