Lindsey Vonn competes with a torn ACL. Why that may work for some.

Anyone with even the faintest interest in winter sports has likely heard about Lindsey Vonn’s ACL injury. What’s remarkable is that she has said she’ll attempt to compete in the Olympics with a torn ACL. That often surprises people — I hear from friends and patients all the time — because the common assumption is that if you tear your ACL, reconstruction is mandatory.

She’s a very special case. So let’s talk more generally, about typical patients. It’s not necessarily true that you must have your ACL reconstructed. The primary reason we consider ACL reconstruction is to restore stability to the knee — and stability matters for several reasons.

In the short term, most people simply don’t like the uncertainty of an unstable knee. Pivoting or twisting activities — soccer, tennis, pickleball — or even everyday situations like navigating a crowded sidewalk and changing direction quickly can lead to buckling. That unpredictability affects quality of life and confidence, and reconstruction can allow people to return to the sports and activities that are part of their social and physical routine.

There’s also a joint-preservation aspect. An unstable knee that buckles repeatedly places the meniscus at risk. I often compare it to jumping a curb with your car — each impact increases the chance of damaging the tire. Similarly, each episode of knee instability increases the risk of meniscal injury or further damage. And meniscal health plays a major role in the long-term development of arthritis. If your meniscus is intact, preserving it is valuable — and you’re more likely to preserve it with a stable knee.

On the other hand, if you don’t participate in higher-risk activities — perhaps you prefer cycling or other low-impact exercise — and especially if you’re older or have a partial tear, non-operative treatment may be reasonable to consider.

But if you’re younger, want to return to cutting or pivoting sports, and your meniscus is still intact at the time of injury, my general recommendation is to restore as much stability to the knee as possible — both for current function and long-term joint health.