Knee Leg

A specialist physiotherapist has claimed the NHS could save significant amounts of money by treating anterior cruciate ligament (ACL) damage with physiotherapy rather than surgery. 

Richard Norris is an orthopaedic physio specialist for lower limbs at Warrington and Halton Hospitals NHS Foundation Trust. 

In a bid to ‘benchmark’ his trust’s approach – in which only one patient in three with an ACL rupture has reconstructive surgery and the rest join tailor-made rehab – Mr Norris asked hospitals in his area about their approach. The survey revealed wide variations in the proportion of patients undergoing surgery for ACL damage. 

‘Some trusts operate on all patients with an ACL rupture, some on two in three or three of four, and some didn’t know the proportion managed conservatively.’ 

Mr Norris works alongside consultant orthopaedic surgeon Mike McNicholas, who helped to conduct an internal audit at the trust in 2002. 

This found that around two-thirds of patients with an isolated ACL injury did not need reconstructive surgery if they completed a physiotherapy-based ACL deficient programme.

Mr Norris says that a larger Swedish study published in 2010 in the New England Journal of Medicine reached a similar conclusion. 

He estimates that the Warrington ACL deficient programme costs just £90 per patient, whereas surgery costs around £2,500 plus rehab costs. 

‘It’s not clear why there’s the variation, whether people do things because that is how they have always done it, or because they’re not aware of the research,’ Mr Norris said. 

‘But trusts could save a lot of money and we’re keen to raise the awareness of what we’ve been doing.’ 

He has helped to develop a programme that aims to reduce the chances of ACL injuries occurring during sports activities, for example. ‘The Liverpool Ladies Football Club have recently implemented the programme into their training sessions,’ Mr Norris added.