If my brother reads this column, he won’t be too pleased with me.
After all, would you want everyone to know that the knee injury you suffered took place when you — an adult — tried to put a move on a 9-year-old in touch football?
Well, it turned out that the loud pop we all heard as Jonathan crumpled to the ground on Thanksgiving morning in 2008 was a blown ACL, or anterior cruciate ligament. In the ensuing two years, numerous family members have urged my brother to have surgery, but he’s refused.
Earlier this month, I read about a new study that is raising questions about the best way to treat a torn ACL. Do we need to stop hounding my brother?
Dr. Prescott prescribes:
Laying aside questions of Cohen family psychology, a study published last month in The New England Journal of Medicine should stir significant debate about whether knee surgery is a “must” for a blown ACL. At the very least, the findings suggest that there are nonsurgical options, even for those who wish to return to active lifestyles.
For the study, researchers recruited more than 100 subjects who’d torn their ACLs. The ACL is one of the main ligaments of the knee, connecting the thigh and shinbone. When it’s torn, the knee usually becomes unstable.
The researchers randomly assigned subjects to two groups. The first group received physical therapy followed by surgery, while the second received only physical therapy.
After two years, doctors performed a comprehensive assessment that evaluated function, pain and other factors. They found that both groups had improved considerably: Those with surgically repaired knees had improved by 39.2 percent, and those who’d undergone only physical therapy improved by 39.4 percent.
In other words, the outcomes were essentially identical.
This, of course, flies in the face of practice, particularly among athletes, for whom surgery is the near-universal response to ACL tears. For example, Chipper Jones of baseball’s Atlanta Braves underwent surgery less than four days after tearing his ACL earlier this month.
In the study, the surgically repaired knees were found to be more stable. This is in line with a 2009 study that found that, 10 years after surgery, surgically repaired knees were more stable. But they were not fundamentally healthier than those treated only with physical therapy. Indeed, that study reported nearly identical numbers on patients’ ability to return to sports and whether they experienced subsequent knee problems.
Although the jury is still out, it appears that surgery to the replace the ACL (either with tissue from elsewhere in the leg or from a cadaver) could lead to better outcomes in those who intend to return to sports involving cutting, pivoting or planting. But if your active life is limited to in-line activities such as running and biking, there seems to be no downside to starting a good rehabilitation program and waiting to decide if surgery is warranted.