By Michael Ingle
APA Titled Musculoskeletal Physiotherapist
This blog is part two in a series about ACL injuries by APA Musculoskeletal Physiotherapist Michael Ingle.
For part one please click here
Michael is an experienced in treating ACL tears of the knee and recently presented on the topic to the Choosing Wisely Australia National Conference (choosingwisely.org.au).
Does ACL surgery prevent knee osteoarthritis?
In the second part of the ACL blog, the topic of discussion is whether having surgery for a torn ACL prevents the knee getting arthritis. This is an important topic, because we know that people who have a joint trauma such as an ACL tear are at higher risk of getting knee osteoarthritis.
ACL injuries increase your risk of knee osteoarthritis – what does the research say?
A recent article led by Australian researcher Dr Kate Webster of La Trobe University looked at all the relevant studies on long-term risk of knee osteoarthritis after ACL injury. They found 13 studies (systematic reviews) had been performed on the topic. Unfortunately, there was a near 7-fold increase in the risk of knee osteoarthritis following an ACL injury compared to the non-injured population.
This confirms that people who have had an ACL tear are at high risk of arthritis in their knee long term (although, osteoarthritis risk can be minimised with structured joint strengthening exercise, maintaining a healthy body weight and looking after your general physical and mental health).
This review of all available studies found that people who had had an ACL reconstruction were not less likely to get knee osteoarthritis. Wanting to prevent or delay arthritis is a common reason why people undergo surgery. It’s often believed that if the extra laxity (looseness) that a knee has after an ACL tear is not addressed surgically, the knee will be likely to give way easily, further injuring the joint structures and wearing them out faster.
This result certainly challenges current thinking on this topic, especially in light of further recent randomised controlled trial research which shows that many people can cope in the long term without an ACL (Reijman et al 2021).
What does this mean for me if I have torn my ACL?
If you have injured your ACL, research evidence suggests commencing structured and intensive rehabilitation with an experienced physiotherapist prior to considering a surgical reconstruction. Surgical reconstruction should not be performed for the purpose of wishing to prevent knee arthritis (though can be performed for reasons like persistent knee giving way).
Webster and Hewett (2021). Anterior Cruciate Ligament Injury and Knee Osteoarthritis: An Umbrella Systematic Review and Meta-analysis, Clinical Journal of Sports Medicine, 3.
Reijman M, Eggerding V, van Es E, van Arkel E, van den Brand I, van Linge J, Zijl J, Waarsing E, Bierma-Zeinstra S and Meuffels D (2021). Early surgical reconstruction versus rehabilitation with effective delayed reconstruction for patients with anterior cruciate ligament rupture: COMPARE randomised controlled trial. British Medical Journal, 372 (n375).