Why you should reconsider knee surgery!

Medscape Medical News
Patients With Anterior Cruciate Ligament Injuries May Not Need Surgery

News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd

December 12, 2008 — Patients with anterior cruciate ligament (ACL) injuries may not need surgery, according to the results of a study reported in the December 15 issue of Arthritis Care & Research. At 2 to 5 years after injury, muscle strength and function were similar in patients treated with training and surgical reconstruction or training only.

"...ACL injuries are associated with the development of osteoarthritis (OA) in the long term, leading to pain, functional limitations, and decline in quality of life in the young or middle-aged adult," write Eva Ageberg, PT, PhD, from Lund University in Lund, Sweden, and colleagues. "There is no evidence to suggest that reconstruction of the ACL prevents or reduces the rate of early-onset OA. On the contrary, the prevalence of OA may be even higher in patients with reconstructed ACL than in those with nonreconstructed ACL."

Because the role of reconstructive surgery in restoring muscle function is unclear, the goal of this study was to evaluate muscle strength and functional performance in patients with ACL injury with or without surgical reconstruction 2 to 5 years after injury.

Of 121 patients with ACL injury enrolled in a randomized controlled trial comparing training and surgical reconstruction vs training only, 54 underwent follow-up evaluation 2 to 5 years after injury.

Mean age at follow-up was 30 years (age range, 20 - 39 years), 28% were women, and mean duration of follow-up was 3 ± 0.9 years.

Evaluation included reliable, valid single tests and test batteries for strength (knee extension, knee flexion, leg press) and hop performance (vertical jump, 1-leg hop, side hop). Analysis of variance for comparisons between groups was performed with the Limb Symmetry Index (injured leg divided by uninjured and multiplied by 100), with a Limb Symmetry Index of more than 90% considered normal.

The surgical and nonsurgical treatment groups did not differ in muscle strength or functional performance. Muscle function was normal in 44% to 89% of subjects on the single tests and in 44% to 56% in the test batteries.

Limitations of the study include lack of evidence as to whether surgical or nonsurgical treatment is best for these patients in overall outcome.

"The lack of differences between patients treated with training and surgical reconstruction or training only indicates that reconstructive surgery is not a prerequisite for restoring muscle function," the study authors write. "Abnormal muscle function, found in approximately one-third or more of the patients, may be a predictor of future knee OA."

The Swedish National Centre for Research in Sports, the Swedish Research Council, the Swedish Rheumatism Association, Region Skåne, the Local Research and Development Council of Göteborg and Southern Bohuslän, and the Faculty of Medicine, Lund University, supported this study. The original KANON study, from which patients were included, was also supported by Pfizer Global Research, Thelma Zoegas Fund, the Swedish National Centre for Research in Sports, and the Stig & Ragna Gorthon Research Fund.

Arthritis Care Res. 2008;59:1773-1779.

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