23 Jul, 2010 in
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By Trying Knee Rehab Earliest, Many May Avoid ACL Surgery By Reviewed By July 21, 2010 — Many patients with a torn ACL — the ligament that stabilizes the knee — may avoid surgery by delaying the operation as well as earliest giving material therapy a try. One of the most feared sports as well as work injuries is a torn anterior cruciate ligament or ACL. It’s the tough piece of tissue that keeps the knee from bending sideways when you plant your foot as well as pivot. Nobody is exactly sure of the best way to treat a torn ACL. Yet every year, at least 200,000 Americans undergo ACL reconstruction, in which the ACL is restored with tendon grafts. Most patients undergo this surgery soon after their injury. But that may not be the best strategy for everyone, suggests a clinical trial by physiotherapist Richard B. Frobell, PhD, of Sweden’s Lund University, as well as colleagues. ACL: To Operate or Not?Frobell’s team randomly assigned 121 immature, active adults — many of them highly competitive, non-professional athletes — to two dissimilar treatments. Both groups underwent a highly structured rehabilitation program in which they worked up from improving balance as well as coordination to knee strengthening exercises. One group underwent ACL reconstruction within 10 weeks of injury. But the other group delayed ACL reconstruction until it became obvious they needed it — or until they healed. Two years later, both groups had pleasant results. Neither treatment strategy was best than the other. But there was one big difference: 60% of those who delayed surgery found they never needed the operation. “A lot of people say you need ACL surgery incase you want to return to sports. But our results show we may be best off incase we start with rehabilitation,” Frobell tells WebMD. “Then we can lower the number of people needing surgery.”
Many Factors Involved in ACL TreatmentMayo Clinic orthopaedic surgeon Bruce A. Levy, MD, is filled of praise for the Frobell study. But he warns that some patients risk further damage to their knees by delaying ACL reconstruction. The injury that rips the ACL may damage other parts of the knee, particularly the meniscus — the piece of cartilage that cushions the bones of the knee. “If you possess a large meniscus tear as well as you fix the meniscus as well as not the ACL, there is a very high likelihood the ACL will fail,” Levy tells WebMD. On the other hand, a patient who is a relatively low-level recreational athlete — Levy offers the example of a 35-year-old cyclist — may be best off with bracing as well as rehabilitation. Only incase such patients possess further ACL problems would surgery be the preferred option. But a collegiate soccer player may not be capable to return to play without ACL reconstruction. “When a patient presents with an ACL tear in the knee, we possess a extended discussion with the patient as well as family on the pros as well as cons of operative as well as nonoperative treatment,” Levy says. “The decision is based on many factors. Earliest as well as foremost is the patient’s activity level, as well as the sport as well as work demands the knee would undergo.” Frobell fully agrees with Levy that the study does not give patients or doctors a one-size-fits-all solution to treatment of ACL tears. “Our study does not answer the question of specifically who needs ACL surgery. It does not look into what factors a patient has to possess to need surgery to do well,” he says. “We need a lot of more high-quality science in this area.” Some of that data may be coming soon. Levy says he’d similar to see how Frobell’s patients do in the extended term. Frobell says the final patient in the study is just completing five years of follow-up observation. More information is on the way. The Frobell study, as well as an editorial by Levy, appear in the July 22 issue of the Recent England Journal of Medicine. SOURCES: Frobell, R.B. Recent England Journal of Medicine, July 22, 2010; vol 363: pp 331-342. |
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