Shortly after winning the U.S. Open, Tiger Woods announced he was sitting out the rest of the PGA tour to have ACL reconstruction surgery on his left knee.
Is Tiger Woods’ surgery the right thing for his knee? Maybe not, according to research funded in part by the Arthritis Foundation. Martin Englund, MD, PhD, of Boston University School of Medicine, and a team of physicians from Lund University in Sweden, have determined that reconstructing a ruptured anterior cruciate ligament (ACL) and removing torn meniscal tissue greatly increases your risk of developing knee osteoarthritis. Woods may just be setting himself up for debilitating arthritis in the future.
Whether or not to have a torn ACL replaced is a decision a lot of athletes – professionals and weekend warriors – have to make. For the professionals, like Tiger Woods, the decision is fairly clear. To be able to continue his sport at an elite level, Tiger Woods’ knee must be stabilized through reconstructive surgery. However, for those who suffer an ACL tear but are willing to change their activity level, foregoing surgery and teaching their muscles to compensate for the deficiency may well be their best long-term option.
ACL ruptures are often accompanied by meniscal tears – commonly called “torn cartilage.” Removal of damaged menisci is a known strong risk factor for knee OA. During ACL reconstruction, surgeons generally will try to repair any accompanying meniscal tear or clean out torn pieces of meniscal tissue, whereas the patient or surgeon may not opt for surgery solely to repair or remove a torn meniscus.
The ACL-Arthritis Connection
About half of people who tear an ACL have it surgically reconstructed. Studies have shown, however, that although ACL reconstruction does stabilize the knee, it does not seem to decrease the risk of developing OA. Dr. Englund and his team found that people with ACL tears could achieve good function and avoid OA development through a program of rehabilitation and activity modification instead of ACL reconstruction.
In their study, 100 patients with an acute ACL injury were recruited and recommended not to have their ACL surgically reconstructed, but to undergo a period of physical therapy and to modify their physical activities. The participants underwent eight weeks of physical therapy. Therapy focused on regaining joint mobility and improving neuromuscular function – allowing muscles in the leg to compensate for the deficient ACL, providing stability. After 15 years, the participants were contacted again and invited to participate in a follow-up exam.
At the follow-up, those participants with intact menisci and non-reconstructed knees achieved the best scores for pain, symptoms, activities, recreation and quality of life.
The study authors conclude, “Our study thus clearly confirms that in the ACL-injured knee, reconstructed or not, a meniscectomy is a potent risk factor for OA. Preservation of the meniscus seems beneficial irrespective of whether an ACL reconstruction was performed. In patients with ACL injury willing to moderate their activity level, initial treatment without ACL reconstruction should be considered.” That said, time will tell the implications of Tiger Woods’ knee surgery.
Anterior cruciate ligament: One of four major ligaments of the knee. It is one of the most commonly injured knee ligaments.
Meniscus: C-shaped cartilage-like tissues located between the bones of the knee. They help the knee to function properly by bearing load, absorbing shock, stabilizing the joint and providing lubrication.
Read more about Dr. Englund's study on ACL reconstruction and OA in Research Update.