To cut or not to cut, that is the question ~ by David J. Adams

Maybe it’s the icy, slippery, hazards of manoeuvring in a northern climate or perhaps it’s my own injury while skiing (thank you moguls of Whistler), but winter always reminds me of ACL injuries. So many seem to have an ACL story, especially if they’re active.  In our last post, Dr. Roald Bahr discussed ACL injury prevention. In this post, we’d like to draw your attention to three BJSM podcast interviews with physiotherapist, researcher, and CSM co-author, Dr. Richard Frobell, from Lund University in southern Sweden.

“Do I need surgery?” is a common question amongst those who have suffered an ACL injury. Dr. Frobell is first author on a five-year study comparing outcome of patients who were randomized to early ACL reconstruction or rehabilitation first with the option of reconstruction if it was needed.

In the first of three podcasts, Frobell talks with Karim Khan, CSM co-author and editor-in-chief of the BJSM, about the implications of the study. Frobell points out how these two treatments were never previously compared in high quality trials and the study results drew a lot of attention. They suggest that several people do indeed need ACL reconstruction, but it would be equally wrong to say everyone needs one as much as no one does. Frobell states that it’s possible to do as well without surgery.

Photo by “toivo.” Used with permission. All rights reserved. Source: flickr

Photo by “toivo.” Used with permission. All rights reserved. Source: flickr

The challenge is one doesn’t know who will do well without surgery. The study reveals that after five years there was no difference or at least statistical difference between those who had surgery first and those who started first with rehabilitation and took a wait and see approach.

One concern of not having or even delaying surgery is the risk of osteoarthritis. After five years, the risks of osteoarthritis and meniscal surgery were no higher for those treated with physiotherapy alone.

In the second podcast, Dr. Frobell addresses the criticisms that followed the study and how the results were not necessarily what people “expected or hoped for.”

In the third in the series, Frobell discusses his recommendations for clients who have suffered an ACL injury. The podcast is directed towards patients and would be appreciated by anyone who is questioning whether or not to have ACL reconstruction.

For an in-depth look at ACL injuries and treatment options, including surgery and rehabilitation, turn to Chapter 32 “Acute knee injuries” in Clinical Sports Medicine.

Fast Facts

  • An anterior cruciate ligament (ACL) injury is usually caused by a sudden twisting motion in the knee when an athlete lands or steps.
  • Young women are two to eight times more likely than young men to injure the ACL.
  • Landing on the balls of your feet, rather than flat-footed, may help prevent ACL injuries.

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