ACL Problems Discussion
March 7, 2011 by Dr. Marc Darrow, M.D.
Filed under Knee Pain
Discussions from our Radio Show on ACL Problems:
A CALLER WITH ACL PROBLEMS
CALLER: I am a tennis pro and I have played tennis for years and I have also played soccer and I have had three surgeries and I have permanent pain in my right knee.
Dr. Darrow: The caller had a torn ACL, he had one surgery several years ago where they actually cut open (an incision), because I remember the scar on his leg, (that had) to be at least a foot long. Back then the surgery was very evasive, now they do it an arthroscope. But even then many of these ACL surgeries are unnecessary. Doctors are trained to think that the ACLs are pretty much necessary and any one who rips one can’t be an athlete. But we find that many athletes go on and compete without them. So we just stabilize the ligaments in the knee and people with deficient ACLs can still do their sport.
Dr. Gene: You are saying that if you saw this Caller a few years ago you obviously would not have suggested that surgery.
Dr. Darrow: I never suggest surgery unless it is absolutely necessary. Generally for an ACL I would like to wait a couple months and see if the injury calms down. There are many studies on the ACL, that the results are much better if the patient waits (on surgery). There are some who just jump right into the surgery and then the person has a longer rehabilitation period.
Dr. Gene: How long should someone wait, the caller is a professional tennis player, if he had to get back on the court in a hurry, how long?
Dr. Darrow: The problem is this. When someone tears an ACL or a big ligament like that. You just can’t go back and play tennis right away, the rehabilitation from ACL is long and extensive before that donor ligament is “matured” is at least nine months. Most of these people who have had them done, if they go and do any sports that have any degree of twisting of the leg before that time will rip it again. You have to be very careful.
ACL REVISION SURGERY
Researchers writing in the American Journal of Sports Medicine looked at “revision anterior cruciate ligament surgery (to) determine the association between stability and functional results”
What they found was “Revision (ACL) surgery allowed approximately 60% of patients to go back to sports, most of them at lower levels than their prerevision function,” and that “patients who undergo revision anterior cruciate ligament surgery should be counseled as to the expected outcome and cautioned that this procedure probably represents a salvage situation and may not allow them to return to their desired levels of function.”
Battaglia MJ 2nd, Cordasco FA, Hannafin JA, Rodeo SA, O’brien SJ, Altchek DW, Cavanaugh J, Wickiewicz TL, Warren RF.Results of Revision Anterior Cruciate Ligament Surgery.Am J Sports Med. 2007 Oct 11
MRI Reliability in ACL Ruptures
Researchers writing in the Korean Journal of Radiology say that MR imaging itself is not a reliable examination to predict stability of the ACL rupture outcome, even when the MR images show an intact appearance of the ACL.
Chung HW, Ahn JH, Ahn JM, Yoon YC, Hong HP, Yoo SY, Kim S. Anterior Cruciate Ligament Tear: Reliability of MR Imaging to Predict Stability after Conservative Treatment. Korean J Radiol. 2007 May-Jun;8(3):236-41.
