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Bob's ACL WWWBoard
Re: ACL surgery v "conservative" treatment study
Posted By: SueBW
Date: Tuesday, 11 March 2008, at 9:26 a.m.
In Response To: ACL surgery v "conservative" treatment study (Sondra)
I attended the meeting and, although I missed this paper, I heard several other long-term studies in which a high incidence of radiographic osteoarthritis was noted after ACL reconstruction. One study compared PT autografts to hamstring autografts and noted no difference in this variable between graft types.
In all of these studies unfortunately, a high incidence of meniscectomy existed, which really precludes all other variables in terms of the expected condition of the knee joint 10 years after surgery or injury. In addition, many patients in these studies waited years before undergoing ACL reconstruction. By that time, most had either already undergone meniscectomy, or required removal of meniscus tissue with the ACL reconstruction as a result of repeated reinjuries.
I think the 2 of the most important prognostic factors in ACL-injured knees are the ability to save the meniscus and the extent of bone bruising that occurred as documented by MRI. Loss of the majority of one (or both) meniscus or severe bone bruising appear to lead the patient down the path of OA, regardless of the surgeon's ability to restore normal stability. However, the restoration of stability probably buys time (years) before the expected OA symptoms, so it is still justified.
SueBW
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