9057
0
Posted on Oct 24, 2006, 1 p.m.
By Bill Freeman
Surgery may not be the best option for certain sports-related knee injuries, particularly anterior cruciate ligament (ACL) tears, according to an orthopedic surgeon from California. He warns that it could lead to the development of early arthritis, particularly when the athlete returns to the playing field soon after repair.
"One of the most important under-reported stories in sports medicine is the alarming rate of early arthritis occurring in many knees that have undergone ligament reconstruction or cartilage surgery," Dr. Scott Dye, from the California Pacific Medical Center and UC San Francisco, said in a statement.
"There is, for example, published data to indicate that as many as 70 percent of knees that have had ACL reconstructive surgery are developing early arthritis," he added.
ACL reconstruction is a commonly performed surgery and is based largely on a structural orthopedic paradigm, Dye explained in a telephone interview with Reuters Health. "That is, if one does a well done ACL reconstruction and puts in a new ligament and thereby restores normal structural biomechanical characteristics to the ligament, then one has essentially 'fixed' the knee."
Once "fixed," the belief has been that it's okay to resume sports activities. "In fact, there is a very trendy concept in physical therapy these days called accelerated rehab," Dye said.
It's also been assumed that arthritis will be prevented in the knee that is "fixed" structurally. On the contrary, "we're finding that just the opposite is happening," Dye said.
In long-term studies of knees that have undergone ACL reconstructive surgery, with an early return to sport, "the shocking story," Dye said, "is that many of the knees are developing arthritis very early and even rapidly -- within the first several years."
Doctors can now identify knees that are at risk for developing early arthritis following sports injury with a metabolic imaging study called a "Technetium" bone scan, years before the arthritis shows up on a traditional x-ray or MRI.
"At-risk" knees are less apt to develop arthritis if the bone scan returns to normal following treatment, whether surgical or not. In many people, Dye said, this can be achieved simply by modifying activities to reduce the "loads" or stress on the injured knee to levels it can biologically tolerate.
"If one stays within a certain range of loading -- what I call the envelope of load acceptance -- then the knee will not only function normally from a structural standpoint but normally from a physiologic standpoint," Dye said.
Individuals with no pain or soreness whatsoever in the knees are probably in their envelope of load acceptance, Dye said.
However, there are many people doing activities with low grade symptoms -- just a little bit of soreness -- whose x-rays may look normal but who may in fact be in the early stages of arthritis. "These patients ought to have a bone scan done early and then do whatever it takes to get that bone scan to come back to normal," Dye recommends.
This may mean switching from high-demand pivoting sports such as tennis, racquetball, or soccer to swimming or bicycling.
