Skiing on Hope: Can You Treat an ACL Tear Without Surgery?

Posted on: February 11th, 2026 by Our Team

This ski season — and especially at the 2026 Winter Olympics — all eyes were on Lindsey Vonn as she attempted to compete in the downhill just one week after completely rupturing her anterior cruciate ligament (ACL) in a World Cup downhill crash. Despite bone bruising and meniscal damage, she trained and even skied at elite speeds with a brace, tapping into remarkable conditioning and neuromuscular control to stabilize her knee on the course. While her second injury and subsequent outcome on Sunday morning were not what she anticipated, her effort is a striking example of how some individuals — particularly elite athletes — can function with an ACL injury without immediate surgery.

While most amateur athletes and active adults won’t find themselves in the Olympics, Vonn’s story highlights an important truth: non-surgical management of ACL injuries is possible for select patients, and with the right rehabilitation and conditioning, many can maintain good function and quality of life. But it’s crucial to understand who these patients are, the potential risks of remaining ACL-deficient, and how structured care — including bracing and targeted conditioning — plays a central role.

What Is an ACL and Why Does It Matter?

The anterior cruciate ligament (ACL) is a key ligament in the knee, providing stability, particularly during activities involving pivoting, cutting, and rapid decelerations. When the ACL is torn, the knee becomes unstable — especially with movements that involve twisting or lateral forces.

In the absence of a functioning ACL, abnormal motion can occur. Over time, this can increase stress on other structures of the knee, especially the meniscus and articular cartilage — the shock absorbers and smooth gliding surfaces of the joint.

Is Non-Surgical Treatment a Real Option?

Yes — for many individuals, non-surgical (conservative) management can be a valid option, especially when:

• The patient has a low grade partial ACL tear
• There is no significant instability with daily activities
• Rehabilitation can fully restore muscle strength and neuromuscular control
• Activities do not require high-demand cutting or pivoting

A growing body of research suggests that physiotherapy-led non-operative management can improve pain and function in selected patients with partial or even complete ACL tears — though high-quality randomized data remains limited.

One systematic review reported that non-operative treatment with structured rehabilitation can be effective for improving function and knee stability — particularly when neuromuscular training is emphasized.

What Happens to the Meniscus and Cartilage Without a Functional ACL?

One of the biggest concerns with conservative ACL treatment — especially in active individuals — is the secondary damage to the meniscus and cartilage:

Meniscus Tears

• Up to 66% of ACL injuries are associated with meniscus tears at the time of injury.
• Without the ACL, increased tibial translation and instability can place excess load on the menisci, especially the medial meniscus, increasing the risk of tears over time.

Cartilage Damage and Osteoarthritis

• Instability and abnormal knee mechanics can lead to accelerated cartilage wear.
• Over years, this contributes to post-traumatic osteoarthritis (PTOA) — often the long-term consequence that patients most want to avoid.

Thus, while some people can function reasonably well without an ACL, the long-term risk of meniscus and cartilage damage is real and significant — especially if instability continues or isn’t properly addressed.

Why Can Some People “Cope” Better Without Surgery?

Not everyone with an ACL tear experiences the same degree of instability. A few factors influence how well someone can function:

1. Muscular Strength and Conditioning – Strong quadriceps, hamstrings, and hip stabilizers can substitute — to a degree — for the stabilizing role of the ACL, helping control anterior tibial translation and dynamic knee stability.
2. Neuromuscular Control – People who develop excellent proprioception (the body’s sense of joint position) and neuromuscular reflexes through rehabilitation can better stabilize the knee during daily activities and even moderate sports.
3. Activity Level – Someone who engages in low-impact activities (walking, cycling, swimming) is generally more likely to do well without immediate surgery compared with someone who plays pivoting sports like soccer or basketball.
4. Size and Body Mechanics – Individual biomechanics — including limb alignment and body weight — affect knee stability. Some people simply have favorable mechanics that reduce symptomatic instability.

The Role of Conditioning and Bracing

If non-surgical management is pursued, the key all comes down to rehabilitation and support:

Structured Rehabilitation

A functional, criterion-based rehabilitation program is essential. These programs focus on:

• Strengthening muscles around the knee
• Improving balance and neuromuscular control
• Gradual progression to higher-level activities
• Meeting objective return-to-activity criteria

Protocols often follow stepwise progressions to ensure safety and efficacy.

Bracing

Functional knee braces can provide additional mechanical support during activities that provoke instability. While they don’t replicate the ACL’s function fully, they can help patients feel more secure and reduce episodes of giving way.

For athletes like Lindsey Vonn, bracing combined with elite conditioning can allow participation in high-demand sports even with an ACL deficiency — a scenario that underscores the strength of targeted neuromuscular control and physical preparation.

Who Should Consider Non-Surgical Management?

Non-operative treatment is best suited for:

• Patients with low-grade partial ACL tears
• Individuals with minimal instability in day-to-day life
• People willing to commit to a rigorous rehabilitation plan
• Those whose activity goals don’t require high-demand pivoting
• Patients with medical or surgical contraindications

It is not usually recommended for:

• Young, competitive athletes in pivoting sports
• Individuals who experience symptomatic knee instability
• People with concurrent meniscal root tears or significant cartilage injury

Each case must be individualized, and shared decision-making with an Orthopaedic specialist is essential.

Final Thoughts

The idea of treating an ACL tear without surgery is not just theoretical; it’s supported by clinical practice and growing evidence. However, this approach requires structured rehabilitation, realistic expectations, and close monitoring for secondary injuries like meniscus tears and early arthritis.

Lindsey Vonn’s remarkable effort to ski with a torn ACL highlights both the possibility and limitations of non-operative function — especially at the highest level of sport. For most patients, the decision should be rooted in personal goals, functional demands, and detailed clinical evaluation.

If you’ve experienced an ACL injury and are weighing non-surgical versus surgical options, a thorough assessment can help guide the best path for your knee health and long-term activity goals.

Want to Learn More?

Dr. Ronak M. Patel specializes in complex knee injuries and ACL surgery. If you have suffered a knee injury or have been diagnosed with an ACL tear, a comprehensive evaluation with Dr. Patel can assist in discovering your treatment options.