I feel a bit like a “stuck record”, although this is an analogy that younger people might not understand. Maybe a “GIF” stuck on repeat. Anyway. Here we go again, let me say it once more: The indication for ACL reconstruction is not "ACL injury".
Rather, the reason for a patient having an ACL reconstruction is "instability after ACL injury, in spite of a period of good rehab". So, there is actually nothing different about Karen’s approach.
This is how I have treated ACL injuries for years. And about ⅔ of the patients that I see with ACL injuries end up having surgery. So, not everyone, but it still has a place when rehab doesn’t quite get the patient where they want to be. This is supported by a paper that I co-authored some years ago (the patients were all under my care), published in the Journal of Knee Surgery:
A Dawson, JD Hutchison, AG Sutherland. J Knee Surg 2016; 29(1): 74-9.
I’m slightly surprised that St John of God Warrnambool should support an article that only shows one side of the discussion, but there you go.
If you have an ACL injury, you should start rehabilitation with an experienced physiotherapist early. You should discuss your progress and your goals. You should also consider a discussion with a surgeon who regularly treats ACL injuries, about the practicalities and goals of surgery. Some people do really well with rehab, and go back to sports. Some people do well enough with rehab, but decide not to go back to sports. But some people want to go back to sports but cannot because the knee is still unstable, or the knee is still unstable in daily activities, despite good rehab. Those are the people who should consider ACL reconstruction.
So many shades of grey.