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.
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.
Anatomy basics
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.
For more about osteoarthritis (OA), visit Arthritis Today's Focus on OA pages. Read more about Dr. Englund's study on ACL reconstruction and OA in Research Update.
Looks like the authors do not respond to comments. So, here is my take as someone who had surgery for an ACL and meniscus tears.
The meniscus provides a shock absorber function for your knee. It provides a cushion between the cartilege endings of your shin and thigh bones. When it is torn, it can not fully provide this function. Portions of a torn meniscus can also wedge in the joint causing a 'locked' knee.
The danger I see is infection followed by injury induced arthritis. Realistically, much of that arthritis risk will depend on your activity level and how long you will live. To give you an idea, I had surgery at age 20. Here it is 20+ years later, and I am now developing arthritis which is significantly limiting my athletics. But realistically, are you a runner now? Do you do free weight workouts that include squats? If the answer is no, then my personal opinion is to consider the surgery.
In any event, please get a second opinion. In some instances, if the tear is not truly debilitating, it is best to do nothing. Good luck.
Thank you for your help.
X Ray & MRI Done.
The doctor I am consulting is having 25 years of experience had suggested me that performing Physiotherapy exercise which has 4 tough ways of performing upto 6 weeks & even later regularly with motivation.Doctor has challenged that by physio exercise the blood vessels of the torn ACL would get contact and later may be the ligament get contact with same strength as before.
Could you please guide I am 36 years of age, Indian, working as an Accountant but very sportive in all games.
Thank you & Best Regards
also wondering if i am a likely candidate for knee replacement?? can you have knee replacement done if you have an ACL injury? would a knee replacement take care of any ACL problems?
Thanx for your time and expertise.
Had I elected to forgo the surgery, I would not be able to have the lifestyle I still enjoy now. If there is a greater chance that I will suffer from OA in the future, well then, so be it. I will cross that bridge when I come to it.
But for the time being, I have to enjoy my life at its fullest. My ACL Reconstructive Surgery has extended my sports life and I am eternally grateful to Dr. Kitaoka of Kanazawa University, Japan, for helping me to make that decision.
I am a 69 years old woman,and I had an accident/fall skiing on the 29 apr.2009. XR didn,t show anything .I left the emmergency room diagnosed with ACL wearing a zimmer leg support .I started Intensive Phisio Therapy after a week of icing and topical antiimflammatory on my L.knee.and not wearing my Zimmer support.My MD and Phisio therapist didn,t agreed with diagnose.On 19 may MRI done.Showed all my ligaments and tendons beeing intact,but I had subacute osteochondral fracture,undisplaced,of the posteolateral margin of the tibial plateau with intense subjacent marrow edema and @least a partial freedetached of meniscal fragment medially or laterally.Should I have a cast,what is my next treatment?I have a balance gait ,@times I am tingling on outter aspect of my L.leg reflecting up and down of my knee.I regained full ROM and I am doing isometric tense Quads. exercises,genoflexions to 90 degrees angle,streching and avoiding turning in the spots .I feel compacted on my knee.Please I need your advice.Things moves v.slowly and I don,t know if I am dooing the right things.Thanks.
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